Cardiopulmonary Bypass Standby Avoids Fatality due to Vascular Laceration in Laser-Assisted Lead Extraction

Wang, Wei; Wang, Xiaowei; Modry, Dennis L.; Wang, Shaohua

doi:10.1111/jocs.12294

Cited by 27 publications

(42 citation statements)

References 12 publications

(18 reference statements)

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“…Our technique differs from that described by Wang et al 10 success rate of lead extraction in a randomized trial reported in 1999 where all lead extractions were performed by electrophysiologists who are trained in residency programs to perform lead extraction and our success complication rates are consistent with this data. 11 Furthermore, the availability of high resolution fixed imaging in the hybrid OR facilitated visualization as leads were extracted.…”

Section: Discussionsupporting

confidence: 87%

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Surgical Management of Major Intrathoracic Hemorrhage Resulting from High-Risk Transvenous Pacemaker/Defibrillator Lead Extraction

et al. 2014

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A method, based on well-established trauma principles, is described for surgical management of serious intrathoracic bleeding complications that can occur during the extraction of pacemaker or defibrillator leads. Using this method, four patients who experienced rapid hemodynamic deterioration due to traumatic injury of the superior vena cava and its tributaries during defibrillator lead extraction underwent successful surgical repair. Perioperative preparation for high-risk lead extractions, management of major bleeding complications, and surgical repair techniques are discussed. Major bleeding complications can be managed effectively with this strategy leading to excellent overall success rates for extractions without mortality.

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Section: Discussionsupporting

confidence: 87%

“…Our technique differs from that described by Wang et al because we have chosen to have electrophysiologists perform lead extraction. The 97% technical success rate we achieved in comparison to the 84.3% recorded by Wang et al may be attributable to the expertise of the electrophysiologists in lead extraction techniques.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Major Intrathoracic Hemorrhage Resulting from High-Risk Transvenous Pacemaker/Defibrillator Lead Extraction

et al. 2014

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“…6 The rate of injury varies from below 1% in highly experienced centers to over 3% with less experienced operators. [7][8][9][10] No data are available with respect to the population-based rate of complications or perforation. However, at a rate of 2%, an estimated 200 to 300 potentially fatal injuries may occur per year, though this number could be substantially higher.…”

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confidence: 99%

“…Although 2 recent papers have appropriately described surgical management techniques in small series of injuries, there remains a paucity of information. 9,12 In the absence of a systematic examination of a large number of these injuries, a lack of consensus regarding management techniques is present. Even in centers that have the facility to immediately repair 2 Bashir et al Surgical Repair Lead Extraction Injury these injuries, the sporadic nature of these complications may leave the surgeon with no frame of reference or experience.…”

mentioning

confidence: 99%

Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction

Bashir

Fedoruk

Ofiesh

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Injuries to cardiac and venous structures during pacemaker and defibrillator lead extraction are serious complications that have been studied poorly. The incidence of these injuries is unknown but likely underestimated. No systematic multicenter review of these injuries or their management has been undertaken. Methods and Results-We interrogated our mandatory administrative database for all excimer laser extractions that sustained a cardiac or venous injury in the province of British Columbia. Injuries were classified according to presentation and compared with respect to nature of injury, type of repair, utilization of cardiopulmonary bypass, and outcome. Of 1082 excimer laser extractions over 19 years, 33 sustained an injury (3.0%). The majority of injuries occurred in women (21/33; 63.6%), and median age of oldest lead extracted was 10.8 (7.5, 12.2) years. A type 1 presentation, defined as circulatory collapse, was found in 12/33 patients (36.4%). A type 2 presentation, defined as progressive hypotension responsive to treatment, was found in 20/33 patients (60.6%). Over half the patients had a moderate or large injury, and cardiopulmonary bypass was required in 13 patients with extensive injury. Despite the presence of devastating injuries, the immediate availability of aggressive salvage measures resulted in a survival of 87.9% of patients at 30 days. Conclusions-The immediate availability of a cardiovascular surgeon, perfusionist, and cardiopulmonary bypass pump facilitates lifesaving repair of injuries sustained during laser lead extraction. The size and complexity of injury correlates closely with the presentation, blood loss, and need for cardiopulmonary bypass to facilitate repair. (Circ Arrhythm Electrophysiol. 2016;9:e003741.

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“…In these cases, emergency sternotomy with establishment of cardiopulmonary bypass (CPB) and vascular or cardiac repair is essential to decrease mortality risk . The relative roles of the cardiac surgeon and the cardiac electrophysiologist in lead extraction procedures have been much debated and even recent articles from this Journal have advocated in favor of both the cardiac surgeon and cardiac electrophysiologist as the sole operator. In our institutional protocol, these procedures are performed jointly by both professionals, which we believe is the safest approach.…”

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confidence: 99%

Value of a Joint Cardiac Surgery-Cardiac Electrophysiology Approach to Lead Extraction

et al. 2015

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We report three cases of vascular injury during laser lead extractions, requiring urgent surgical correction. Immediate sternotomy and cardiopulmonary bypass were possible because of an institutional collaboration where cardiac surgeon and cardiac electrophysiologist jointly perform these cases, and all patients survived. We propose this joint approach is ultimately the best option for patients undergoing lead extraction.

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Cardiopulmonary Bypass Standby Avoids Fatality due to Vascular Laceration in Laser-Assisted Lead Extraction

Abstract: Cardiopulmonary bypass standby is helpful when performing laser-assisted lead extraction to treat potentially fatal vascular laceration. Dual-coil lead is an independent risk factor to predict intraoperative vascular laceration.

Cited by 27 publications

References 12 publications

Surgical Management of Major Intrathoracic Hemorrhage Resulting from High-Risk Transvenous Pacemaker/Defibrillator Lead Extraction

Surgical Management of Major Intrathoracic Hemorrhage Resulting from High-Risk Transvenous Pacemaker/Defibrillator Lead Extraction

Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction

Value of a Joint Cardiac Surgery-Cardiac Electrophysiology Approach to Lead Extraction

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