Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678795
Oral Presentations
Sunday, February 17, 2019
DGTHG: Arrhythmie/Sondenextraktion/Schrittmachertherapie
Georg Thieme Verlag KG Stuttgart · New York

In-Hospital Mortality after Transvenous Lead Extraction

J.T. Demal
1   Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
,
S. Pecha
1   Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
,
L. Castro
1   Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
,
J. Vogler
2   Universitäres Herzzentrum Lübeck, Medizinische Klinik II/Kardiologie, Angiologie, Intensivmedizin, Lübeck, Germany
,
N. Gosau
3   Universitäres Herzzentrum Hamburg, Klinik für Kardiologie - Schwerpunkt Elektrophysiologie, Hamburg, Germany
,
M. Linder
4   Universitäres Herzzentrum Hamburg, Klinik für Allgemeine und Interventionelle Kardiologie, Hamburg, Germany
,
S. Willems
3   Universitäres Herzzentrum Hamburg, Klinik für Kardiologie - Schwerpunkt Elektrophysiologie, Hamburg, Germany
,
H. Reichenspurner
1   Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
,
S. Hakmi
1   Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

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Objectives: Little data exist on in-hospital mortality rates following transvenous lead extraction (TLE). We sought to identify predictors for in-hospital mortality in a large cohort of patients undergoing TLE in a high-volume lead extraction center.

Methods: A total of 201 patients who underwent TLE procedures using different extraction tools at our university center between January 2012 and August 2017 were prospectively registered in a dedicated database. Demographic, clinical, and follow-up characteristics were retrospectively analyzed.

Results: Mean age was 65.8 ± 15.0 and 149 patients were male (74.1%). Indications for TLE were local infections (37.4%), systemic infections (26.7%), lead dysfunctions (21.0%), and other indications (14.9%). The mean lead dwell time was 7.7 ± 5.9 years. Complete clinical success was achieved in 94.0% of the cases. The rate of overall complications was 3.0%. Eleven of 201 patients died during the same hospital stay (mortality rate 5.5%). In nine of these cases, patients showed signs of infection at least 2 weeks before the TLE procedure. Leading causes of death were sepsis or sepsis correlated complications (n = 9, 81.8%). Hereby, staphylococcal species were the most common pathogen species. Systemic infection was significantly more often the indication for lead extraction in patients, which afterward died in hospital in comparison to patients which survived until discharge (n = 10 [90.9%] vs. n = 44 [23.9%], p < 0.00001). Other predictors for in-hospital death were chronic kidney disease (n = 7 [63.6%] vs. n = 46 [30.7%], p = 0.042) and lead vegetations in transesophageal echocardiography (n = 6 [54.5%] vs. n = 36 [20.0%], p = 0.007). The presence of procedural complications was not a significant predictor for in-hospital mortality.

Conclusion: TLEs are associated with low mortality rates and low rates of periprocedural complications, but for patients suffering from chronic kidney disease or presenting with systemic infection with or without lead vegetations in echocardiography. To prevent a fatal course in these high-risk patients, the early diagnosis of device or lead infections followed by TLE is important and might reduce in-hospital mortality.