The Challenge of Aggressive Adhesions: Tool Combination for Successful Lead Extraction

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Year Published: 
2017

Linder M, Pecha S, Castro L, Zipfel S, Gosau N, Willems S, Reichenspurner H, Hakmi S.

Thorac Cardiovasc Surg. 2017;65(S01):S1-S110.

Abstract

Objectives: Extraction of old pacemaker (PM) and implantable cardioverter defibrillator (ICD) leads with aggressive adhesions can be very challenging. Furthermore, the presence of abandoned lead fragments adds to the complexity of an extraction procedure. The aim of this study was to present our experience with combination of different extraction tools, to enhance procedural success rate in those challenging cases.

Methods: A total of 161 consecutive PM and ICD lead extraction procedures has been performed between 01/2012 and 08/2016. We here present a series of 12 cases where one extraction tool was not sufficient to achieve complete procedural success and combination of two or more extraction tools was necessary. All extraction procedures were performed in a hybrid operating room, having patients under general anesthesia with continuous invasive arterial blood pressure and 3D TEE monitoring.

Results: Patients were 63 ± 14 years of age, 41.7% were female. A total of 35 leads (22 PM leads, 7 single-coil lCD leads and 6 dual-coil ICD leads) with a mean implantation duration of 127.2 ± 77.8 months had to be extracted. In 6 cases laser sheaths and mechanical extraction tools were combined. Combination of laser sheaths and femoral snares was used in 3 cases, while simultaneous use of mechanical extraction sheaths and femoral snares was necessary in 3 cases. With combination of these different extraction tools, a clinical as well as procedural success rate of 100% was achieved in all cases. No peri-procedural death was observed and no major or minor complications occurred during lead extraction procedures.

Conclusion: In cases of severe calcified adhesions or abandoned lead fragments, one extraction tool often is not enough to achieve complete procedural success. In those procedures, the combination of different extraction tools using a hybrid operating room, allows for safe extraction with success rates up to 100%.

Link to abstract on The Thoracic and Cardiovascular Surgeon