Cardiac surgeon and electrophysiologist shoulder-to-shoulder approach

Hybrid room, a kingdom for two. A zero mortality transvenous lead extraction single center experience

Maurizio Roberto, Rita Sicuso, Sabrina Manganiello, Valentina Catto, Luca Salvi, Matteo Nafi, Michela Casella, Fabiana Rossi, Francesco Grillo, Matteo Saccocci, Alessio Gasperetti, Rosario Cervellione, Davide Carcione, Francesco Alamanni, Claudio Tondo, Antonio Dello Russo

Research output: Contribution to journalArticle

Abstract

Background: Nowadays, transvenous lead extraction (TLE) is considered an essential technique in lead management strategy. Since 2011, a multidisciplinary approach was undertaken in our centre involving electrophysiologists, cardiac surgeons and anaesthesiologists to improve cross- unit cooperation and minimize complications and mortality. The present paper reports procedural outcomes and complications of our lead extraction experience. Methods: We retrospectively collected and analysed data from all consecutive patients undergoing cardiac implantable electronic device leads TLE at the IRCCS Centro Cardiologico Monzino between January 2011 and November 2017. Results: One-hundred fifty patients (111 males, 68 ± 13 years) underwent extraction procedures. The most common extraction indication were infections (86.7%) and TLE was carried out by laser-based approach in 88 (58.6%) patients, by mechanical dilating sheaths in 58 (38.7%) patients and by a combined approach (TLE + open surgical intervention) in 4 (2.7%) patients. Procedural success was obtained in 146 (97.3%) cases with only 3 (2.0%) major complications with 2 cases of structural injury with tamponade requiring emergent median sternotomy. Open surgery extraction was required in 4 patients, after an attempt to TLE, due to leads strict adhesion to cardiac or vascular structures, whereas in 5 (3.3%) cases, the treatment of choice was a combined approach consisting in transvenous leads extraction followed by planned surgery. Conclusions: TLE is a complex procedure that sometimes leads to fatal complications. In our single center experience, a multidisciplinary approach involving electrophysiologist, cardiac surgeon, anaesthesiologist in an operating room allows a safer approach and major complications treatment.

Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Mortality
Sternotomy
Lead
Surgeons
Operating Rooms
Blood Vessels
Lasers
Equipment and Supplies
Wounds and Injuries
Therapeutics
Infection

Keywords

  • Cardiac implantable electronic device
  • Lead extraction
  • Lead extraction technique
  • Lead-related complications
  • Multidisciplinary team

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{2adab29f33024815ae3358487716908d,
title = "Cardiac surgeon and electrophysiologist shoulder-to-shoulder approach: Hybrid room, a kingdom for two. A zero mortality transvenous lead extraction single center experience",
abstract = "Background: Nowadays, transvenous lead extraction (TLE) is considered an essential technique in lead management strategy. Since 2011, a multidisciplinary approach was undertaken in our centre involving electrophysiologists, cardiac surgeons and anaesthesiologists to improve cross- unit cooperation and minimize complications and mortality. The present paper reports procedural outcomes and complications of our lead extraction experience. Methods: We retrospectively collected and analysed data from all consecutive patients undergoing cardiac implantable electronic device leads TLE at the IRCCS Centro Cardiologico Monzino between January 2011 and November 2017. Results: One-hundred fifty patients (111 males, 68 ± 13 years) underwent extraction procedures. The most common extraction indication were infections (86.7{\%}) and TLE was carried out by laser-based approach in 88 (58.6{\%}) patients, by mechanical dilating sheaths in 58 (38.7{\%}) patients and by a combined approach (TLE + open surgical intervention) in 4 (2.7{\%}) patients. Procedural success was obtained in 146 (97.3{\%}) cases with only 3 (2.0{\%}) major complications with 2 cases of structural injury with tamponade requiring emergent median sternotomy. Open surgery extraction was required in 4 patients, after an attempt to TLE, due to leads strict adhesion to cardiac or vascular structures, whereas in 5 (3.3{\%}) cases, the treatment of choice was a combined approach consisting in transvenous leads extraction followed by planned surgery. Conclusions: TLE is a complex procedure that sometimes leads to fatal complications. In our single center experience, a multidisciplinary approach involving electrophysiologist, cardiac surgeon, anaesthesiologist in an operating room allows a safer approach and major complications treatment.",
keywords = "Cardiac implantable electronic device, Lead extraction, Lead extraction technique, Lead-related complications, Multidisciplinary team",
author = "Maurizio Roberto and Rita Sicuso and Sabrina Manganiello and Valentina Catto and Luca Salvi and Matteo Nafi and Michela Casella and Fabiana Rossi and Francesco Grillo and Matteo Saccocci and Alessio Gasperetti and Rosario Cervellione and Davide Carcione and Francesco Alamanni and Claudio Tondo and {Dello Russo}, Antonio",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ijcard.2018.12.074",
language = "English",
journal = "International Journal of Cardiology",
issn = "0167-5273",
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TY - JOUR

T1 - Cardiac surgeon and electrophysiologist shoulder-to-shoulder approach

T2 - Hybrid room, a kingdom for two. A zero mortality transvenous lead extraction single center experience

AU - Roberto, Maurizio

AU - Sicuso, Rita

AU - Manganiello, Sabrina

AU - Catto, Valentina

AU - Salvi, Luca

AU - Nafi, Matteo

AU - Casella, Michela

AU - Rossi, Fabiana

AU - Grillo, Francesco

AU - Saccocci, Matteo

AU - Gasperetti, Alessio

AU - Cervellione, Rosario

AU - Carcione, Davide

AU - Alamanni, Francesco

AU - Tondo, Claudio

AU - Dello Russo, Antonio

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Nowadays, transvenous lead extraction (TLE) is considered an essential technique in lead management strategy. Since 2011, a multidisciplinary approach was undertaken in our centre involving electrophysiologists, cardiac surgeons and anaesthesiologists to improve cross- unit cooperation and minimize complications and mortality. The present paper reports procedural outcomes and complications of our lead extraction experience. Methods: We retrospectively collected and analysed data from all consecutive patients undergoing cardiac implantable electronic device leads TLE at the IRCCS Centro Cardiologico Monzino between January 2011 and November 2017. Results: One-hundred fifty patients (111 males, 68 ± 13 years) underwent extraction procedures. The most common extraction indication were infections (86.7%) and TLE was carried out by laser-based approach in 88 (58.6%) patients, by mechanical dilating sheaths in 58 (38.7%) patients and by a combined approach (TLE + open surgical intervention) in 4 (2.7%) patients. Procedural success was obtained in 146 (97.3%) cases with only 3 (2.0%) major complications with 2 cases of structural injury with tamponade requiring emergent median sternotomy. Open surgery extraction was required in 4 patients, after an attempt to TLE, due to leads strict adhesion to cardiac or vascular structures, whereas in 5 (3.3%) cases, the treatment of choice was a combined approach consisting in transvenous leads extraction followed by planned surgery. Conclusions: TLE is a complex procedure that sometimes leads to fatal complications. In our single center experience, a multidisciplinary approach involving electrophysiologist, cardiac surgeon, anaesthesiologist in an operating room allows a safer approach and major complications treatment.

AB - Background: Nowadays, transvenous lead extraction (TLE) is considered an essential technique in lead management strategy. Since 2011, a multidisciplinary approach was undertaken in our centre involving electrophysiologists, cardiac surgeons and anaesthesiologists to improve cross- unit cooperation and minimize complications and mortality. The present paper reports procedural outcomes and complications of our lead extraction experience. Methods: We retrospectively collected and analysed data from all consecutive patients undergoing cardiac implantable electronic device leads TLE at the IRCCS Centro Cardiologico Monzino between January 2011 and November 2017. Results: One-hundred fifty patients (111 males, 68 ± 13 years) underwent extraction procedures. The most common extraction indication were infections (86.7%) and TLE was carried out by laser-based approach in 88 (58.6%) patients, by mechanical dilating sheaths in 58 (38.7%) patients and by a combined approach (TLE + open surgical intervention) in 4 (2.7%) patients. Procedural success was obtained in 146 (97.3%) cases with only 3 (2.0%) major complications with 2 cases of structural injury with tamponade requiring emergent median sternotomy. Open surgery extraction was required in 4 patients, after an attempt to TLE, due to leads strict adhesion to cardiac or vascular structures, whereas in 5 (3.3%) cases, the treatment of choice was a combined approach consisting in transvenous leads extraction followed by planned surgery. Conclusions: TLE is a complex procedure that sometimes leads to fatal complications. In our single center experience, a multidisciplinary approach involving electrophysiologist, cardiac surgeon, anaesthesiologist in an operating room allows a safer approach and major complications treatment.

KW - Cardiac implantable electronic device

KW - Lead extraction

KW - Lead extraction technique

KW - Lead-related complications

KW - Multidisciplinary team

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U2 - 10.1016/j.ijcard.2018.12.074

DO - 10.1016/j.ijcard.2018.12.074

M3 - Article

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -