Łukasz Tułecki1, Marek Czajkowski2, Sylwia Targońska2, Konrad Tomków1, Dorota Nowosielecka3, Wojciech Jacheć4, Anna Polewczyk5, Andrzej Kutarski6. 1. Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamosc, Poland. 2. Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland. 3. Department of Cardiology, The Pope John Paul II Province Hospital, Zamosc, Poland. 4. 2 Department of Cardiology, Silesian Medical University, Zabrze, Poland. 5. Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland. 6. Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Abstract
Introduction: The guidelines stress the importance of cardiac surgery in the management of life-threatening complications arising from lead removal. Aim: To delineate the roles of the cardiac surgeon during transvenous lead extraction (TLE). Material and methods: 3207 patients (38.7% F), average age 65.7 years, underwent the extraction of PM/ICD leads using standard non-powered mechanical systems within the last 14 years. Results: Procedural success 96.1%, clinical success 97.8%, procedure-related death 0.18%, major complications 1.9% (cardiac tamponade 1.2%, hemothorax 0.2%, tricuspid valve damage 0.3%, stroke and pulmonary embolism < 1%). The roles for cardiac surgery in TLE have been categorized into five areas: 1. Emergency cardiac surgery (1.18% of all patients), 2. Late surgical intervention (TLE-related tricuspid valve dysfunction) (0.44%), 3. Cardiac surgery complementing partially successful TLE (0.68%: removal of lead fragments), 4. Epicardial pacemaker implantation through sternotomy for the above-mentioned reasons (0.65%), 5. Delayed surgical intervention after TLE to place epicardial LV leads (0.53%). Additionally, surgical experience can help in prevention and treatment of wound infection after TLE. Conclusions: Emergency cardiac surgery (mainly due to severe bleeding) is still the most frequent reason for intervention (33.63% (38/113) of all surgical procedures). The other areas of surgical interventions in lead management are: cardiac surgery complementing partially successful TLE, repair or replacement of the malfunctioning tricuspid valve secondary to lead extraction and implantation of permanent epicardial pacing leads after sternotomy or epicardial left ventricle lead to optimize cardiac resynchronization. Experience of a single high-volume lead extraction center confirms the need for close collaboration between the cardiologist and the cardiac surgeon, whose role goes far beyond mere surgical standby. Copyright:
Introduction: The guidelines stress the importance of cardiac surgery in the management of life-threatening complications arising from lead removal. Aim: To delineate the roles of the cardiac surgeon during transvenous lead extraction (TLE). Material and methods: 3207 patients (38.7% F), average age 65.7 years, underwent the extraction of PM/ICD leads using standard non-powered mechanical systems within the last 14 years. Results: Procedural success 96.1%, clinical success 97.8%, procedure-related death 0.18%, major complications 1.9% (cardiac tamponade 1.2%, hemothorax 0.2%, tricuspid valve damage 0.3%, stroke and pulmonary embolism < 1%). The roles for cardiac surgery in TLE have been categorized into five areas: 1. Emergency cardiac surgery (1.18% of all patients), 2. Late surgical intervention (TLE-related tricuspid valve dysfunction) (0.44%), 3. Cardiac surgery complementing partially successful TLE (0.68%: removal of lead fragments), 4. Epicardial pacemaker implantation through sternotomy for the above-mentioned reasons (0.65%), 5. Delayed surgical intervention after TLE to place epicardial LV leads (0.53%). Additionally, surgical experience can help in prevention and treatment of wound infection after TLE. Conclusions: Emergency cardiac surgery (mainly due to severe bleeding) is still the most frequent reason for intervention (33.63% (38/113) of all surgical procedures). The other areas of surgical interventions in lead management are: cardiac surgery complementing partially successful TLE, repair or replacement of the malfunctioning tricuspid valve secondary to lead extraction and implantation of permanent epicardial pacing leads after sternotomy or epicardial left ventricle lead to optimize cardiac resynchronization. Experience of a single high-volume lead extraction center confirms the need for close collaboration between the cardiologist and the cardiac surgeon, whose role goes far beyond mere surgical standby. Copyright:
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