Replies

• Very interesting and novel extraction tool!  Will look forward to further reports on experience with this device.
  August 11, 2023

• Saw the article.  It looked really intriguing.  I'd love to hear more about it. Also, did you have any cases with occlusion of the innominate?  In those cases, I guess you just treat the SVC.   Tom
  June 21, 2023

• Thanks for sharing the case.  These are very challenging leads with very low tensile strength.  They begin to stretch and fall apart when even very light traction is applied.  Even with dwell times of only a year or two, extraction of this lead can be difficult.  Tensile strength is a bit better for this lead if not cut, so we have moved to prepping the lead with a locking stylet down the intact lead and use very strong suture with a constrictor knot or the compression coil.  Snaring from below at the outset can also improve the ability to extract these leads. With the leads now broken and no ability to place a locking stylet, extraction will be very challenging and the ability to create a rail for the extraction tools will be negligible.  The remaining leads may come out piece by piece with a snare, but you might consider moving directly to a surgical approach.
  April 24, 2023

• Nice case and excellent discussion of the approach to management of CIEDs and leads for patients needing radiation therapy.  Most often, we don't see significant performance issues for CIEDs after XRT.
  February 15, 2023

• Interesting case!  Of course, one has to consider all of the clinical factors, but assuming the patient is not very frail, I would favor open surgical extraction.  The surgeons will be able to debride this very large vegetation.  They may find the cardiac involvement greater than what is seen on the TOE.  Our experience is that even TOE underestimates actual infectious involvement of the cardiac structures.  I'd be concerned about Option 1, TLE, as embolization of this very large vegetation into the PA may result in hemodynamic collapse acutely.  Additionally, the patient would be left with this large burden of infected tissue which may make him or her more prone to SIRS or persistent bacteremia.   Just my thoughts.  Thanks for sharing the case!
  December 5, 2022