Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

Abstract

Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.

Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance

“…Procedure complexity was expressed as all lead extraction time (“sheath to sheath time”) and average time of single lead extraction (sheath-to sheath/number of extracted leads) and the necessity utility of second line tools and advanced tools [ 10 , 11 , 23 , 24 , 25 , 26 , 27 ].…”

“…Unexpected procedure difficulty so-called “technical problems” during TLE—situations which increased procedure complexity but not being complications. They were: break of extracted lead, loss of broken lead fragment—when main part of the lead was dilated and removed but remained free both endings, movable lead fragment which flowed usually info pulmonary vascular bed, block in lead venous entry/subclavian region block in lead venous entry preventing entry into the subclavian vein with a polypropylene catheter, Byrd dilator collapse/fracture, two leads strong scar connection, necessity to utilise other approach than lead venous entry and dislodgement of functional lead [ 10 , 11 , 24 , 25 , 26 , 27 ].…”

“…A combined approach, using two or more different (jugular, subclavian, femoral) access sites, was selected when conventional methods would be ineffective (lead proximal end in the cardiovascular space or in case of lead fracture). Laser and electrosurgical dissection sheaths were not used [ 10 , 24 , 25 , 26 ].…”

“…Over 17 years the organizational model of lead extraction evolved from procedures performed in the electrophysiology laboratory using intravenous analgesia/sedation [ 10 ] to procedures performed in the hybrid room in patients under general anesthesia. For the last 7 years, the core extraction team has consisted of the same highly experienced TLE operator, experienced echocardiographer and dedicated cardiac surgeon [ 24 , 25 , 26 ].…”

Transvenous Lead Extraction Procedure—Indications, Methods, and Complications

“…Tricuspid valve damage with worsening tricuspid regurgitation is considered another complication. The number of extracted leads, extraction of abandoned lead(s), extraction of leads with redundant loops, and also extraction leads placed in the right ventricle, were reported as the risk factors for tricuspid valve damage and cardiac/vascular wall during TLE [ 51 ].…”