Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths
Background Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effec...
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| Veröffentlicht in: | Pacing and clinical electrophysiology 2023-08, Vol.46 (8), p.960-968 |
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| creator | Migliore, Federico Pittorru, Raimondo Dall'Aglio, Pietro Bernardo De Lazzari, Manuel Falzone, Pasquale Valerio Sottini, Simone Dentico, Alessia Ferrieri, Alessandra Pradegan, Nicola Bertaglia, Emanuele Iliceto, Sabino Gerosa, Gino Tarzia, Vincenzo Carretta, Domenico |
| description | Background
Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE.
Methods
The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA).
Results
The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p |
| doi_str_mv | 10.1111/pace.14696 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2790049227</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2848645221</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3936-b7e8f7fe07770ee929e09a6ba3db916b874fd790474d0a90099319da5d1113153</originalsourceid><addsrcrecordid>eNp90UtLxDAQB_AgiruuXvwAEvAiQnXSpk1zlMUXCOtBzyVNp7tZ2mZNWh_f3uxDDx7MJUP45U8yQ8gpgysW1vVKabxiPJPZHhmzlEOUs1TukzEwLqI8yeWIHHm_BIAMeHpIRkkmU8ZyGJPlbOi1bdFTW9Peqc6_Y2cHTxtUFcXPcKR7YztqOmp1b-fYKWcCo4M33ZyWpjION0Q11Nle7coW9UJ1RofSL1D1C39MDmrVeDzZ7RPyenf7Mn2Inmb3j9Obp0gnMsmiUmBeixpBCAGIMpYIUmWlSqpSsqzMBa8rIYELXoGSAFImTFYqrUIvEpYmE3KxzV05-zag74vWeI1NozoMPyvicBm4jGMR6PkfurSDC88PKud5xtM4ZkFdbpV21nuHdbFyplXuq2BQrCdQrCdQbCYQ8NkucihbrH7pT8sDYFvwYRr8-ieqeL6Z3m5DvwF4GpG6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2848645221</pqid></control><display><type>article</type><title>Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths</title><source>Wiley Online Library All Journals</source><creator>Migliore, Federico ; Pittorru, Raimondo ; Dall'Aglio, Pietro Bernardo ; De Lazzari, Manuel ; Falzone, Pasquale Valerio ; Sottini, Simone ; Dentico, Alessia ; Ferrieri, Alessandra ; Pradegan, Nicola ; Bertaglia, Emanuele ; Iliceto, Sabino ; Gerosa, Gino ; Tarzia, Vincenzo ; Carretta, Domenico</creator><creatorcontrib>Migliore, Federico ; Pittorru, Raimondo ; Dall'Aglio, Pietro Bernardo ; De Lazzari, Manuel ; Falzone, Pasquale Valerio ; Sottini, Simone ; Dentico, Alessia ; Ferrieri, Alessandra ; Pradegan, Nicola ; Bertaglia, Emanuele ; Iliceto, Sabino ; Gerosa, Gino ; Tarzia, Vincenzo ; Carretta, Domenico</creatorcontrib><description>Background
Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE.
Methods
The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA).
Results
The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p < .001), and TLE for systemic infection (HR 4.24; 95% CI 1.69–10.66; p = .002).
Conclusions
At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30‐day and mid‐term mortality are significant, especially in the present of specific comorbidities.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.14696</identifier><identifier>PMID: 36951180</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Cardiomyopathy ; cardiovascular implantable electronic device ; Comorbidity ; Disseminated infection ; evolution RL rotational sheaths ; infection ; Ischemia ; Mortality ; Patients ; Population studies ; Safety ; Sheaths ; Success ; transvenous lead extraction</subject><ispartof>Pacing and clinical electrophysiology, 2023-08, Vol.46 (8), p.960-968</ispartof><rights>2023 The Authors. published by Wiley Periodicals LLC.</rights><rights>2023 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3936-b7e8f7fe07770ee929e09a6ba3db916b874fd790474d0a90099319da5d1113153</citedby><cites>FETCH-LOGICAL-c3936-b7e8f7fe07770ee929e09a6ba3db916b874fd790474d0a90099319da5d1113153</cites><orcidid>0000-0002-5572-2620 ; 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.14696$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpace.14696$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36951180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Pittorru, Raimondo</creatorcontrib><creatorcontrib>Dall'Aglio, Pietro Bernardo</creatorcontrib><creatorcontrib>De Lazzari, Manuel</creatorcontrib><creatorcontrib>Falzone, Pasquale Valerio</creatorcontrib><creatorcontrib>Sottini, Simone</creatorcontrib><creatorcontrib>Dentico, Alessia</creatorcontrib><creatorcontrib>Ferrieri, Alessandra</creatorcontrib><creatorcontrib>Pradegan, Nicola</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><creatorcontrib>Iliceto, Sabino</creatorcontrib><creatorcontrib>Gerosa, Gino</creatorcontrib><creatorcontrib>Tarzia, Vincenzo</creatorcontrib><creatorcontrib>Carretta, Domenico</creatorcontrib><title>Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Background
Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE.
Methods
The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA).
Results
The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p < .001), and TLE for systemic infection (HR 4.24; 95% CI 1.69–10.66; p = .002).
Conclusions
At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30‐day and mid‐term mortality are significant, especially in the present of specific comorbidities.</description><subject>Cardiomyopathy</subject><subject>cardiovascular implantable electronic device</subject><subject>Comorbidity</subject><subject>Disseminated infection</subject><subject>evolution RL rotational sheaths</subject><subject>infection</subject><subject>Ischemia</subject><subject>Mortality</subject><subject>Patients</subject><subject>Population studies</subject><subject>Safety</subject><subject>Sheaths</subject><subject>Success</subject><subject>transvenous lead extraction</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp90UtLxDAQB_AgiruuXvwAEvAiQnXSpk1zlMUXCOtBzyVNp7tZ2mZNWh_f3uxDDx7MJUP45U8yQ8gpgysW1vVKabxiPJPZHhmzlEOUs1TukzEwLqI8yeWIHHm_BIAMeHpIRkkmU8ZyGJPlbOi1bdFTW9Peqc6_Y2cHTxtUFcXPcKR7YztqOmp1b-fYKWcCo4M33ZyWpjION0Q11Nle7coW9UJ1RofSL1D1C39MDmrVeDzZ7RPyenf7Mn2Inmb3j9Obp0gnMsmiUmBeixpBCAGIMpYIUmWlSqpSsqzMBa8rIYELXoGSAFImTFYqrUIvEpYmE3KxzV05-zag74vWeI1NozoMPyvicBm4jGMR6PkfurSDC88PKud5xtM4ZkFdbpV21nuHdbFyplXuq2BQrCdQrCdQbCYQ8NkucihbrH7pT8sDYFvwYRr8-ieqeL6Z3m5DvwF4GpG6</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Migliore, Federico</creator><creator>Pittorru, Raimondo</creator><creator>Dall'Aglio, Pietro Bernardo</creator><creator>De Lazzari, Manuel</creator><creator>Falzone, Pasquale Valerio</creator><creator>Sottini, Simone</creator><creator>Dentico, Alessia</creator><creator>Ferrieri, Alessandra</creator><creator>Pradegan, Nicola</creator><creator>Bertaglia, Emanuele</creator><creator>Iliceto, Sabino</creator><creator>Gerosa, Gino</creator><creator>Tarzia, Vincenzo</creator><creator>Carretta, Domenico</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5572-2620</orcidid><orcidid>https://orcid.org/0000-0001-8574-9421</orcidid></search><sort><creationdate>202308</creationdate><title>Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths</title><author>Migliore, Federico ; Pittorru, Raimondo ; Dall'Aglio, Pietro Bernardo ; De Lazzari, Manuel ; Falzone, Pasquale Valerio ; Sottini, Simone ; Dentico, Alessia ; Ferrieri, Alessandra ; Pradegan, Nicola ; Bertaglia, Emanuele ; Iliceto, Sabino ; Gerosa, Gino ; Tarzia, Vincenzo ; Carretta, Domenico</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3936-b7e8f7fe07770ee929e09a6ba3db916b874fd790474d0a90099319da5d1113153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cardiomyopathy</topic><topic>cardiovascular implantable electronic device</topic><topic>Comorbidity</topic><topic>Disseminated infection</topic><topic>evolution RL rotational sheaths</topic><topic>infection</topic><topic>Ischemia</topic><topic>Mortality</topic><topic>Patients</topic><topic>Population studies</topic><topic>Safety</topic><topic>Sheaths</topic><topic>Success</topic><topic>transvenous lead extraction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Pittorru, Raimondo</creatorcontrib><creatorcontrib>Dall'Aglio, Pietro Bernardo</creatorcontrib><creatorcontrib>De Lazzari, Manuel</creatorcontrib><creatorcontrib>Falzone, Pasquale Valerio</creatorcontrib><creatorcontrib>Sottini, Simone</creatorcontrib><creatorcontrib>Dentico, Alessia</creatorcontrib><creatorcontrib>Ferrieri, Alessandra</creatorcontrib><creatorcontrib>Pradegan, Nicola</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><creatorcontrib>Iliceto, Sabino</creatorcontrib><creatorcontrib>Gerosa, Gino</creatorcontrib><creatorcontrib>Tarzia, Vincenzo</creatorcontrib><creatorcontrib>Carretta, Domenico</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</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>Pittorru, Raimondo</au><au>Dall'Aglio, Pietro Bernardo</au><au>De Lazzari, Manuel</au><au>Falzone, Pasquale Valerio</au><au>Sottini, Simone</au><au>Dentico, Alessia</au><au>Ferrieri, Alessandra</au><au>Pradegan, Nicola</au><au>Bertaglia, Emanuele</au><au>Iliceto, Sabino</au><au>Gerosa, Gino</au><au>Tarzia, Vincenzo</au><au>Carretta, Domenico</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2023-08</date><risdate>2023</risdate><volume>46</volume><issue>8</issue><spage>960</spage><epage>968</epage><pages>960-968</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>Background
Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE.
Methods
The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA).
Results
The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p < .001), and TLE for systemic infection (HR 4.24; 95% CI 1.69–10.66; p = .002).
Conclusions
At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30‐day and mid‐term mortality are significant, especially in the present of specific comorbidities.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36951180</pmid><doi>10.1111/pace.14696</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5572-2620</orcidid><orcidid>https://orcid.org/0000-0001-8574-9421</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library All Journals |
| subjects | Cardiomyopathy cardiovascular implantable electronic device Comorbidity Disseminated infection evolution RL rotational sheaths infection Ischemia Mortality Patients Population studies Safety Sheaths Success transvenous lead extraction |
| title | Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths |
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