The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction
Background Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary appr...
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| Veröffentlicht in: | Pacing and clinical electrophysiology 2022-01, Vol.45 (1), p.92-102 |
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| creator | Migliore, Federico Tarzia, Vincenzo Dall'Aglio, Pietro Bernardo Falzone, Pasquale Valerio De Lazzari, Manuel Bottio, Tomaso D'Onofrio, Augusto Padalino, Massimo Vida, Vladimiro Rosso, Jacopo Leoni, Loira Pittarello, Demetrio Bertaglia, Emanuele Iliceto, Sabino Gerosa, Gino |
| description | Background
Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration.
Methods
The study population comprised 84 patients (77% male; mean age 65 ± 18 years) undergoing TLE. After a multidisciplinary evaluation, a combined procedure was considered.
Results
The main indication for TLE was infection in 54 cases (64%). Overall, 152 leads were extracted with a mean implant duration of 94 ± 63 months (range 12–421). Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6% (77/84), 97.6% (82/84), and 98.6% (150/152), respectively. Eighteen combined procedures were performed in 12 patients (14%), such as “hybrid approach” (n = 2) or TLE concomitant to: 1) transcatheter aspiration procedure for large vegetation (n = 8); 2) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); 3) permanent pacing with epicardial leads (n = 6); 4) tricuspid valve replacement (n = 1). One major complication (1.2%) and 11 (13%) minor complications were encountered. No injury to the superior vena cava occurred and no procedure‐related deaths were reported. During a mean time follow‐up of 21 ± 18 months, 17 patients (20%) died. They were more often diabetics (p = .02), and they underwent TLE more often for infection (p = .004).
Conclusions
Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the Evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators. |
| doi_str_mv | 10.1111/pace.14396 |
| format | Article |
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Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration.
Methods
The study population comprised 84 patients (77% male; mean age 65 ± 18 years) undergoing TLE. After a multidisciplinary evaluation, a combined procedure was considered.
Results
The main indication for TLE was infection in 54 cases (64%). Overall, 152 leads were extracted with a mean implant duration of 94 ± 63 months (range 12–421). Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6% (77/84), 97.6% (82/84), and 98.6% (150/152), respectively. Eighteen combined procedures were performed in 12 patients (14%), such as “hybrid approach” (n = 2) or TLE concomitant to: 1) transcatheter aspiration procedure for large vegetation (n = 8); 2) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); 3) permanent pacing with epicardial leads (n = 6); 4) tricuspid valve replacement (n = 1). One major complication (1.2%) and 11 (13%) minor complications were encountered. No injury to the superior vena cava occurred and no procedure‐related deaths were reported. During a mean time follow‐up of 21 ± 18 months, 17 patients (20%) died. They were more often diabetics (p = .02), and they underwent TLE more often for infection (p = .004).
Conclusions
Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the Evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.14396</identifier><identifier>PMID: 34699079</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Cardiac Electrophysiology ; cardiac surgeon ; Cardiologists ; Defibrillators, Implantable ; Device Removal - methods ; Electrodes, Implanted ; electrophysiologist ; Female ; Heart transplantation ; Heart transplants ; Humans ; Interprofessional Relations ; Male ; mechanical lead extraction ; multidisciplinary team ; Pacemaker, Artificial ; Patients ; Population studies ; Prosthesis-Related Infections - therapy ; Success ; Surgeons ; transvenous lead extraction ; Tricuspid valve ; Ventricle</subject><ispartof>Pacing and clinical electrophysiology, 2022-01, Vol.45 (1), p.92-102</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><rights>2022 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3576-75bbbca2c1828f867d01267ed8f9195a2238c9dd0857317581712532eaf4790b3</citedby><cites>FETCH-LOGICAL-c3576-75bbbca2c1828f867d01267ed8f9195a2238c9dd0857317581712532eaf4790b3</cites><orcidid>0000-0002-3878-2904 ; 0000-0001-8574-9421</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpace.14396$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpace.14396$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34699079$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Tarzia, Vincenzo</creatorcontrib><creatorcontrib>Dall'Aglio, Pietro Bernardo</creatorcontrib><creatorcontrib>Falzone, Pasquale Valerio</creatorcontrib><creatorcontrib>De Lazzari, Manuel</creatorcontrib><creatorcontrib>Bottio, Tomaso</creatorcontrib><creatorcontrib>D'Onofrio, Augusto</creatorcontrib><creatorcontrib>Padalino, Massimo</creatorcontrib><creatorcontrib>Vida, Vladimiro</creatorcontrib><creatorcontrib>Rosso, Jacopo</creatorcontrib><creatorcontrib>Leoni, Loira</creatorcontrib><creatorcontrib>Pittarello, Demetrio</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><creatorcontrib>Iliceto, Sabino</creatorcontrib><creatorcontrib>Gerosa, Gino</creatorcontrib><title>The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Background
Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration.
Methods
The study population comprised 84 patients (77% male; mean age 65 ± 18 years) undergoing TLE. After a multidisciplinary evaluation, a combined procedure was considered.
Results
The main indication for TLE was infection in 54 cases (64%). Overall, 152 leads were extracted with a mean implant duration of 94 ± 63 months (range 12–421). Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6% (77/84), 97.6% (82/84), and 98.6% (150/152), respectively. Eighteen combined procedures were performed in 12 patients (14%), such as “hybrid approach” (n = 2) or TLE concomitant to: 1) transcatheter aspiration procedure for large vegetation (n = 8); 2) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); 3) permanent pacing with epicardial leads (n = 6); 4) tricuspid valve replacement (n = 1). One major complication (1.2%) and 11 (13%) minor complications were encountered. No injury to the superior vena cava occurred and no procedure‐related deaths were reported. During a mean time follow‐up of 21 ± 18 months, 17 patients (20%) died. They were more often diabetics (p = .02), and they underwent TLE more often for infection (p = .004).
Conclusions
Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the Evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators.</description><subject>Aged</subject><subject>Cardiac Electrophysiology</subject><subject>cardiac surgeon</subject><subject>Cardiologists</subject><subject>Defibrillators, Implantable</subject><subject>Device Removal - methods</subject><subject>Electrodes, Implanted</subject><subject>electrophysiologist</subject><subject>Female</subject><subject>Heart transplantation</subject><subject>Heart transplants</subject><subject>Humans</subject><subject>Interprofessional Relations</subject><subject>Male</subject><subject>mechanical lead extraction</subject><subject>multidisciplinary team</subject><subject>Pacemaker, Artificial</subject><subject>Patients</subject><subject>Population studies</subject><subject>Prosthesis-Related Infections - therapy</subject><subject>Success</subject><subject>Surgeons</subject><subject>transvenous lead extraction</subject><subject>Tricuspid valve</subject><subject>Ventricle</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoMo7uzoxR8gAS8i9JqkO1_HZVhdYUEP67mpTlfPZEl3xqR7dcAfb8YZPXgwl4TiyVNVvIS84uyKl_N-Dw6veFNb9YSsuGxYZbi0T8mK8UZXpjb2glzm_MAYU6yRz8lF3ShrmbYr8vN-h_QRwgJdQOqnGRO42ceJwhinLXWQeg-O5iVt8VideooB3ZzifnfIPoa49XmmQ0x0TjDlR5zikmmKMxw1EOiIbgeTd-UZEMr3H_O5xwvybICQ8eX5XpOvH27uN7fV3eePnzbXd5WrpVaVll3XORCOG2EGo3TPuFAaezNYbiUIURtn-54ZqWuupeGaC1kLhKHRlnX1mrw9efcpflswz-3os8MQYMIybCukUY1UWvKCvvkHfYhLKmsUSglmBBel3Zq8O1EuxZwTDu0--RHSoeWsPWbSHjNpf2dS4Ndn5dKN2P9F_4RQAH4CvvuAh_-o2i_Xm5uT9Be28JhY</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Migliore, Federico</creator><creator>Tarzia, Vincenzo</creator><creator>Dall'Aglio, Pietro Bernardo</creator><creator>Falzone, Pasquale Valerio</creator><creator>De Lazzari, Manuel</creator><creator>Bottio, Tomaso</creator><creator>D'Onofrio, Augusto</creator><creator>Padalino, Massimo</creator><creator>Vida, Vladimiro</creator><creator>Rosso, Jacopo</creator><creator>Leoni, Loira</creator><creator>Pittarello, Demetrio</creator><creator>Bertaglia, Emanuele</creator><creator>Iliceto, Sabino</creator><creator>Gerosa, Gino</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3878-2904</orcidid><orcidid>https://orcid.org/0000-0001-8574-9421</orcidid></search><sort><creationdate>202201</creationdate><title>The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction</title><author>Migliore, Federico ; Tarzia, Vincenzo ; Dall'Aglio, Pietro Bernardo ; Falzone, Pasquale Valerio ; De Lazzari, Manuel ; Bottio, Tomaso ; D'Onofrio, Augusto ; Padalino, Massimo ; Vida, Vladimiro ; Rosso, Jacopo ; Leoni, Loira ; Pittarello, Demetrio ; Bertaglia, Emanuele ; Iliceto, Sabino ; Gerosa, Gino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3576-75bbbca2c1828f867d01267ed8f9195a2238c9dd0857317581712532eaf4790b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Cardiac Electrophysiology</topic><topic>cardiac surgeon</topic><topic>Cardiologists</topic><topic>Defibrillators, Implantable</topic><topic>Device Removal - methods</topic><topic>Electrodes, Implanted</topic><topic>electrophysiologist</topic><topic>Female</topic><topic>Heart transplantation</topic><topic>Heart transplants</topic><topic>Humans</topic><topic>Interprofessional Relations</topic><topic>Male</topic><topic>mechanical lead extraction</topic><topic>multidisciplinary team</topic><topic>Pacemaker, Artificial</topic><topic>Patients</topic><topic>Population studies</topic><topic>Prosthesis-Related Infections - therapy</topic><topic>Success</topic><topic>Surgeons</topic><topic>transvenous lead extraction</topic><topic>Tricuspid valve</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Tarzia, Vincenzo</creatorcontrib><creatorcontrib>Dall'Aglio, Pietro Bernardo</creatorcontrib><creatorcontrib>Falzone, Pasquale Valerio</creatorcontrib><creatorcontrib>De Lazzari, Manuel</creatorcontrib><creatorcontrib>Bottio, Tomaso</creatorcontrib><creatorcontrib>D'Onofrio, Augusto</creatorcontrib><creatorcontrib>Padalino, Massimo</creatorcontrib><creatorcontrib>Vida, Vladimiro</creatorcontrib><creatorcontrib>Rosso, Jacopo</creatorcontrib><creatorcontrib>Leoni, Loira</creatorcontrib><creatorcontrib>Pittarello, Demetrio</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><creatorcontrib>Iliceto, Sabino</creatorcontrib><creatorcontrib>Gerosa, Gino</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Migliore, Federico</au><au>Tarzia, Vincenzo</au><au>Dall'Aglio, Pietro Bernardo</au><au>Falzone, Pasquale Valerio</au><au>De Lazzari, Manuel</au><au>Bottio, Tomaso</au><au>D'Onofrio, Augusto</au><au>Padalino, Massimo</au><au>Vida, Vladimiro</au><au>Rosso, Jacopo</au><au>Leoni, Loira</au><au>Pittarello, Demetrio</au><au>Bertaglia, Emanuele</au><au>Iliceto, Sabino</au><au>Gerosa, Gino</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2022-01</date><risdate>2022</risdate><volume>45</volume><issue>1</issue><spage>92</spage><epage>102</epage><pages>92-102</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>Background
Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration.
Methods
The study population comprised 84 patients (77% male; mean age 65 ± 18 years) undergoing TLE. After a multidisciplinary evaluation, a combined procedure was considered.
Results
The main indication for TLE was infection in 54 cases (64%). Overall, 152 leads were extracted with a mean implant duration of 94 ± 63 months (range 12–421). Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6% (77/84), 97.6% (82/84), and 98.6% (150/152), respectively. Eighteen combined procedures were performed in 12 patients (14%), such as “hybrid approach” (n = 2) or TLE concomitant to: 1) transcatheter aspiration procedure for large vegetation (n = 8); 2) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); 3) permanent pacing with epicardial leads (n = 6); 4) tricuspid valve replacement (n = 1). One major complication (1.2%) and 11 (13%) minor complications were encountered. No injury to the superior vena cava occurred and no procedure‐related deaths were reported. During a mean time follow‐up of 21 ± 18 months, 17 patients (20%) died. They were more often diabetics (p = .02), and they underwent TLE more often for infection (p = .004).
Conclusions
Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the Evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34699079</pmid><doi>10.1111/pace.14396</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-3878-2904</orcidid><orcidid>https://orcid.org/0000-0001-8574-9421</orcidid></addata></record> |
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| ispartof | Pacing and clinical electrophysiology, 2022-01, Vol.45 (1), p.92-102 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Cardiac Electrophysiology cardiac surgeon Cardiologists Defibrillators, Implantable Device Removal - methods Electrodes, Implanted electrophysiologist Female Heart transplantation Heart transplants Humans Interprofessional Relations Male mechanical lead extraction multidisciplinary team Pacemaker, Artificial Patients Population studies Prosthesis-Related Infections - therapy Success Surgeons transvenous lead extraction Tricuspid valve Ventricle |
| title | The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction |
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