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To grade or not to grade the application of safety requirements for transvenous lead extraction: Experience with 2216 procedures

Jarosław Kosior1, Wojciech Jacheć2, Anna Polewczyk34, Kamil Karpeta5, Paweł Cholewiński5, Marek Czajkowski6, Andrzej Kutarski7
DOI: 10.33963/KP.a2022.0266
·
Pubmed: 36446069
Affiliations
  1. Department of Cardiology, Masovian Specialistic Hospital of Radom, Radom, Poland
  2. 2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Poland
  3. Collegium Medicum of Jan Kochanowski University, Kielce, Poland
  4. Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, Kielce, Poland
  5. Department of Cardiac Surgery Masovian Specialistic Hospital of Radom, Radom, Poland
  6. Department of Cardiac Surgery Medical University of Lublin, Lublin, Poland
  7. Department of Cardiology, Medical University of Lublin, Lublin, Poland

open access

Online first
Original article
Published online: 2022-11-29

Abstract

Background: Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC).

Aims: Assessment of the impact of the organization of TLE on the safety of procedures.

Methods: We analyzed 2216 TLE preformed in two centers in years 2006‒2021 and compared three organizational models of  procedure: (1) TLE in electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation;  (2) TLE with the grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, the remained in EP-LAB); (3) TLE in the hybrid room in all patients under general anaesthesia with transoesophageal echocardiographic (TEE) monitoring. The safety of procedures and mortality after TLE in three-year follow-up were assessed.

Results: The rate of MC in EP-lab was 1.55% and the rate of procedure-related deaths (PRD) was 0.33%. Using the graded approach to safety requirements, the percentage of MC was 2.61% and PRD 0.29%. When performing TLE procedures in the hybrid room, the MC percentage was 1.33% and PRD 0.00%. Long-term survival after TLE was comparable in all study groups.

Conclusions: A key factor in preventing TLE-related deaths is an organization of procedure that enables emergency cardiac surgery. TLE performed in a hybrid room with cardiac surgeon in collaboration and vital signs monitoring appears to be the safest possible option for the patient.  A graded safety approach is associated with the risk of unexpected MC and PRD. Any newly established TLE center can achieve satisfactory results if optimal organizational model of the procedure is used.

Abstract

Background: Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC).

Aims: Assessment of the impact of the organization of TLE on the safety of procedures.

Methods: We analyzed 2216 TLE preformed in two centers in years 2006‒2021 and compared three organizational models of  procedure: (1) TLE in electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation;  (2) TLE with the grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, the remained in EP-LAB); (3) TLE in the hybrid room in all patients under general anaesthesia with transoesophageal echocardiographic (TEE) monitoring. The safety of procedures and mortality after TLE in three-year follow-up were assessed.

Results: The rate of MC in EP-lab was 1.55% and the rate of procedure-related deaths (PRD) was 0.33%. Using the graded approach to safety requirements, the percentage of MC was 2.61% and PRD 0.29%. When performing TLE procedures in the hybrid room, the MC percentage was 1.33% and PRD 0.00%. Long-term survival after TLE was comparable in all study groups.

Conclusions: A key factor in preventing TLE-related deaths is an organization of procedure that enables emergency cardiac surgery. TLE performed in a hybrid room with cardiac surgeon in collaboration and vital signs monitoring appears to be the safest possible option for the patient.  A graded safety approach is associated with the risk of unexpected MC and PRD. Any newly established TLE center can achieve satisfactory results if optimal organizational model of the procedure is used.

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Keywords

transvenous lead extraction, organisational model, safety and effectiveness, long-term survival

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Title

To grade or not to grade the application of safety requirements for transvenous lead extraction: Experience with 2216 procedures

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-11-29

Page views

50

Article views/downloads

40

DOI

10.33963/KP.a2022.0266

Pubmed

36446069

Keywords

transvenous lead extraction
organisational model
safety and effectiveness
long-term survival

Authors

Jarosław Kosior
Wojciech Jacheć
Anna Polewczyk
Kamil Karpeta
Paweł Cholewiński
Marek Czajkowski
Andrzej Kutarski

References (32)
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