Surgical extraction of cardiac implantable electronic device leads based on a heart team approach

• Published in: Journal of cardiology 2023-01, Vol.81 (1), p.111-116
• Main Authors: Mizuno, Tomohiro, Goya, Masahiko, Fujiwara, Tatsuki, Oishi, Kiyotoshi, Takeshita, Masashi, Yashima, Masafumi, Nagaoka, Eiki, Oi, Keiji, Sasano, Tetsuo
• Format: Article
• Language: English
• Subjects: Arrhythmia; Defibrillators, Implantable - adverse effects; Device Removal - methods; Electronics; Heart team; Humans; Implantable electronic device; Infection; Pacemaker; Pacemaker, Artificial - adverse effects; Retrospective Studies; Treatment Outcome; Vena Cava, Superior
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2022.08.013

As cardiac implantable electronic devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization therapies, have become more popular, device extraction has become more frequent. At our institution, individual treatment strategies are discussed at a heart team meeting. Transvenous lead extraction (TVLE) is a first-line treatment; however, surgical lead extraction (SLE) is sometimes selected as a primary choice to provide optimal treatment and maintain the medical safety policy. This study aimed to investigate the validity of this heart team decision-making. From 2013 to 2021, 384 consecutive patients underwent lead extraction at our institution. SLE was proposed as the primary intervention for 21 patients who had high risk of bleeding, difficult TVLE conditions, large vegetations, and other concomitant cardiac diseases. Of the 363 TVLE patients, 10 patients required surgical intervention; 5 had TVLE difficulty followed by SLE and 5 had excessive bleeding. SLE was performed in 26 patients, 19 of whom required valve surgery, and 8 required plication of the great veins. In 4 of the 17 hybrid procedures with SLE and TVLE, excessive bleeding occurred due to laceration of the superior vena cava and innominate vein. Operative mortality was not observed in SLE patients but was observed in 1 of the 4 TVLE patients who required emergent open-chest hemostasis. The heart team discussion was essential to provide optimal treatment and maintain medical safety policies for each patient. SLE should be selected for patients with high risk of TVLE or other cardiac complications such as tricuspid valve incompetence. Treatment strategy for cardiac electronic implantable devices. TVLE, transvenous lead extraction; SLE, surgical lead extraction; SVC, superior vena cava; pts., patients. [Display omitted] •Treatment strategies should be discussed for each patient in a heart team.•Decision-making made by a heart team can provide optimal treatment in each patient.•Surgical lead extraction (SLE) was required in 21 of the 384 patients.•Emergent open-chest hemostasis was required in 4 of the 363 transvenous patients.•Conversion to SLE is smoothly decided after heart team conferences.