Transvenous leads extraction procedures
Procedures were performed in a hybrid operating room or in an operating
room, using mechanical systems such as polypropylene Byrd dilator
sheaths (Cook® Medical, Leechburg, PA, USA), making use of the oblique
cutting edge of the tip to dissect leads from fibrous sheaths that
immobilized the intravascular and/or intracardiac segment of the lead
[11,19]. Procedures were performed in patients under general
anesthesia with full preparation of the surgical field for cardiac
surgery.
Complete procedural success, clinical success and complications of TLE
were defined according to the HRS 2009 and 2017 guidelines and the 2018
EHRA expert consensus statement [1,20,21]. Complete procedural
success was defined as removal of all targeted leads and material, with
the absence of any permanently disabling complication or
procedure-related death. Clinical success was achieved in patients with
retention of a small part of the lead that did not negatively affect the
outcome goals of the procedure [1,20,21].
Major and minor complications were defined according to the 2018 EHRA
Expert Consensus Statement on Lead Extraction [21].
Possible technical problems during TLE include: block in lead venous
entry / subclavian region, necessity utility of Evolution / TigRail
(second line tool in study center), necessity of changing of venous
approach for lead extraction (any reasons), impossible utility of lead
venous entry approach – procedure (since beginning) using another
approach, need to utilise lasso-catheters or basket catheters, extracted
lead break and broken lead remnant extraction, extracted lead break and
abandonment of broken lead fragment, extracted lead fragmentation –
removal in parts, lead to lead strong connection with connecting tissue
scar – terrible both leads separation, collapse / fracture of Byrd
dilator, dislodgement of functional lead, reeling of ICD lead coil.