Efficacy and safety of the extraction of cardiostimulation leads using a mechanical dissection tool. A single center experience

• Published in: Pacing and clinical electrophysiology 2023-03, Vol.46 (3), p.217-225
• Main Authors: Villegas, Elkin González, Juárez del Río, José Ignacio, Carmona, José Carlos Romero, Valdíris, Ulises Ramírez, Peinado, Ángel Aroca, Peinado, Rafael Peinado
• Format: Article
• Language: English
• Subjects: Anesthesia; cardiac implantable electronic device; Cardiovascular system; Defibrillators, Implantable; Device Removal - methods; Dissection; Echocardiography; Evolution; Heart; Humans; implantable cardioverter‐defibrillator; infection; lead extraction; lead extraction techniques; lead‐related complications; Morbidity; Mortality; pacemaker; Pacemaker, Artificial; Retrospective Studies; Statistical analysis; Treatment Outcome; Ventricle
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14625

Background The percutaneous extraction of endovascular cardiostimulation and defibrillation leads is the most frequent technique nowadays. The tools used today must guarantee the success of the procedure, with the minimum of complications. Our objective was to analyze the safety and efficacy of lead extraction using the Evolution mechanical dissection tool (Cook Medical, USA). Methods A retrospective study was carried out in a total of 826 consecutive patients from October 2009 to December 2018 who underwent the procedure with the Evolution mechanical dissection tool. Preoperative study included complete blood tests, echocardiogram, and chest X‐ray. The procedures were performed in the operating room, under general anesthesia and echocardiographic control. Results A total of 1227 leads were extracted with a mean chronicity of 10.3 ± 5.1 years. Clinical success (CS) rate was 99.7%. A total of 16 (1.9%) complications occurred, 2 (0.24%) were major complications and 14 (1.7%) were minor complications. There was no operative mortality. There was no statistically significant relationship between implant chamber and complete efficacy. The complete extraction was achieved in all left ventricular leads, in 762 of 774 (98.45%) of right ventricular lead removal, and in 330 of 334 (98.8%) of right atrial leads (p = .31). Conclusion In our experience, percutaneous extraction of intravenous leads via the use of the Evolution tool (Cook Medical, USA), is a very effective and safe technique that offers low morbidity and mortality.