Abstract 17260: Extraction of Coronary Sinus Lead: A Large Single Center Experience
Implantation of transvenous coronary sinus (CS) lead had become more frequent during the last decade. The extraction of cardiac resynchronization system when needed has increased. There are scanty reports of CS lead extraction involving a few patients. We reviewed a large contemporary experience at a tertiary care facility.
Methods: From January 2004 to November 2009 we did a retrospective study of patients undergoing lead extraction by a single operator. A computerized registry documented extraction data in consecutive patients admitted to our tertiary medical facility. Patient demographics, lead extraction tools, co-morbidities and outcomes were analyzed. All Patients were followed in our office every or by telephone every six month. Laser sheaths (Spectranetics, Colorado Springs, CO) were used in our procedures.
Results: A total of 1,047 chronic endovascular leads were completely removed. From those 100 CS leads were extracted in 98 patients.The devices removed were 97 biventricular-ICDs and 1 biventricular-PMs. In all of them complete lead and hardware extraction was achieved. Mean age of the patient was 68.5±12.5 years (range 34–95) with 76 males and 22 females. Comorbidities consisted of hypertension 92(94%), coronary artery disease 88(90%), and diabetes mellitus 35(35.7%). Congestive heart failure was observed in all subjects. CS lead average implant time was 3.6 ± 4.1 years (1.1–11.2). Simple traction was done in 7(7%) of the leads. Laser sheaths 93 (93%) were used sized12 French (20, 20%), 14 French (67, 67%) and 16 French (6, 6%). The indications for extraction in the patients were device endocarditis (63, 64.3%), pocket infection (17, 17.3%), device malfunction (12, 12.2%), bacteremia (4, 4.1%), upgrade (1,1%), and pain (1,1%). No intraoperative mortality was observed in any of the procedures. Minor pocket hematoma occurred in 5 (5.1%) of the cases. Death for index hospitalization was 6(6.1%). Follow-up showed non-reinfection in patients with reimplanted cardiac device.
Conclusion: Transvenous CS lead extraction is a safe procedure with low perioperative complication rates, which is highly successful in patients with multiple comorbidities.
- © 2010 by American Heart Association, Inc.