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Comparison of Acute and Long-term Outcomes of Evolution® and TightRail™ Mechanical Dilator Sheaths during Transvenous Lead Extraction
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  • Nihan Bahadir,
  • Ugur Canpolat,
  • Ergün Kaya,
  • Levent Şahiner,
  • Hakan Ates,
  • Hikmet Yorgun,
  • Kudret Aytemir
Nihan Bahadir
Hacettepe University Faculty of Medicine
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Ugur Canpolat
Hacettepe University Faculty of Medicine
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Ergün Kaya
Hacettepe University Faculty of Medicine
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Levent Şahiner
Hacettepe University Faculty of Medicine
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Hakan Ates
Hacettepe University
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Hikmet Yorgun
Hacettepe University Faculty of Medicine
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Kudret Aytemir
Hacettepe University Medical Faculty
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Abstract

Background: Powered transvenous lead extraction (TLE) tools are commonly required to remove the leads that have long implant duration due to fibrotic adhesions. However, comparative data are lacking among different types of TLE tools. Aim: To compare the efficacy and safety of two different rotational mechanical dilator sheaths in retrospectively analyzed patients who underwent TLE. Methods and results: A total of 566 lead extractions from 302 patients using TightRailTM (333 lead extractions from 169 patients) and Evolution® (233 lead extractions from 133 patients) mechanical dilator sheaths were performed between July 2009 and June 2018. Acute and long term outcomes of study groups were compared. There is no statistically significant difference between Evolution® and TightRailTM groups in procedural success (93.9% vs. 94%), clinical success (99.2% vs. 98%) and major complications (3.8% vs. 1.2%), respectively (p>0.05). In multivariate regression analysis, lead dwell time, the number of extracted leads, and baseline leukocyte count was found as independent predictors of procedural success (p<0.05). During the median follow-up of 36.6 (0.2-118) months, all-cause mortality was observed in 73 patients (25.6% in the Evolution® vs. 23.1 in the TightRailTM group, p>0.05). Chronic renal disease, heart failure, and coagulopathy were shown as independent predictors of all-cause mortality in multivariate regression analysis (p<0.05). Conclusions: TLE using TightRailTM or Evoluation® mechanical dilator sheaths is a safe and effective therapeutic option. Both mechanical dilator sheaths showed similar efficacy, safety, and all-cause mortality at acute and long-term follow-up of patients who underwent TLE.

Peer review status:Published

05 Oct 2020Submitted to Journal of Cardiovascular Electrophysiology
08 Oct 2020Submission Checks Completed
08 Oct 2020Assigned to Editor
05 Nov 2020Reviewer(s) Assigned
01 Dec 2020Review(s) Completed, Editorial Evaluation Pending
03 Dec 2020Editorial Decision: Revise Minor
06 Dec 20201st Revision Received
08 Dec 2020Assigned to Editor
08 Dec 2020Submission Checks Completed
08 Dec 2020Reviewer(s) Assigned
24 Dec 2020Review(s) Completed, Editorial Evaluation Pending
26 Dec 2020Editorial Decision: Revise Minor
27 Dec 20202nd Revision Received
29 Dec 2020Submission Checks Completed
29 Dec 2020Assigned to Editor
29 Dec 2020Reviewer(s) Assigned
03 Jan 2021Review(s) Completed, Editorial Evaluation Pending
05 Jan 2021Editorial Decision: Accept
25 Mar 2021Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15006