Lead Removal Without Extraction Tools: A Single-Center Experience

Braz J Cardiovasc Surg. 2019 Aug 27;34(4):458-463. doi: 10.21470/1678-9741-2018-0275.

Abstract

Introduction: Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure's outcome but have economic implications.

Objective: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices.

Methods: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes.

Results: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases.

Conclusion: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

Keywords: Lasers; Pacemaker, Artificial; Retrospective Studies; Traction.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacterial Infections / microbiology
  • Catheter-Related Infections* / microbiology
  • Catheters, Indwelling / adverse effects
  • Defibrillators, Implantable
  • Device Removal / instrumentation*
  • Device Removal / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial* / adverse effects
  • Pacemaker, Artificial* / microbiology
  • Retrospective Studies
  • Young Adult