| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2002;73:1893-1896
© 2002 The Society of Thoracic Surgeons
a Divisions of Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
b Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA
* Address reprint requests to Dr Moon, Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, 1 Barnes-Jewish Plaza, St. Louis, MO 63110-1013 USA
e-mail: moonm{at}msnotes.wustl.edu
Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
Background. Extraction of chronically implanted pacing and defibrillator leads has historically been difficult, occasionally requiring open surgical procedures. The purpose of this study was to evaluate the efficacy, safety, and potential need for percutaneous laser-assisted sheath techniques for extraction of chronically implanted leads.
Methods. From January 1999 to August 2001, 128 consecutive patients underwent extraction of 229 leads (138 pacing, 91 defibrillator) in the operating room 61 ± 44 (mean ± standard deviation) months after implantation. Common indications included erosion or pocket infection (41%), lead dysfunction (30%), and sepsis (13%).
Results. Laser techniques were used for 56% ± 4% (104 of 186) of long-term (implanted for more than 1 year) leads, compared with only 16% ± 6% (7 of 43) of short-term (implanted for less than 1 year) leads (p < 0.001). For infected leads, laser was used in 53% ± 5% (49 of 92) with erosion or pocket infections, compared with only 3% ± 4% (1 of 29) with sepsis (p < 0.001). Extraction was complete in 88%, near complete (retained tip) in 10%, and incomplete in 2%. Two patients required a later percutaneous femoral venous approach to remove mobile retained segments, but no patients required cardiac surgery for extraction. Complications included sternotomy for subclavian vein injury (1), chest tube for caval perforation (1), innominate vein thrombosis (1), and partial clavicle removal for subclavian vein repair (2). There were no procedure-related deaths.
Conclusions. Laser-assisted lead extraction is safe, but it is best performed in the operating room; it should be available for long-term leads, except when they are grossly infected, producing sepsis. Laser techniques have essentially eliminated the need for open surgical removal of retained leads.
This article has been cited by other articles:
|
|
 |
|
  J. G. Gaca, B. Lima, C. A. Milano, S. S. Lin, R. D. Davis, J. E. Lowe, and P. K. Smith Laser-assisted extraction of pacemaker and defibrillator leads: the role of the cardiac surgeon. Ann. Thorac. Surg., May 1, 2009; 87(5): 1446 - 1450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. Bongiorni, E. Soldati, G. Zucchelli, A. Di Cori, L. Segreti, R. De Lucia, G. Solarino, A. Balbarini, M. Marzilli, and M. Mariani Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads Eur. Heart J., December 1, 2008; 29(23): 2886 - 2893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Chang, M.-C. Chen, G. B.-F. Guo, and C.-L. Kao Less-Invasive Surgical Extraction of Problematic or Infected Permanent Transvenous Pacemaker System Ann. Thorac. Surg., April 1, 2005; 79(4): 1250 - 1254. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
