Transvenous leads extraction procedures
Procedures were performed in a hybrid operating room or in an operating room, using mechanical systems such as polypropylene Byrd dilator sheaths (Cook® Medical, Leechburg, PA, USA), making use of the oblique cutting edge of the tip to dissect leads from fibrous sheaths that immobilized the intravascular and/or intracardiac segment of the lead [11,19]. Procedures were performed in patients under general anesthesia with full preparation of the surgical field for cardiac surgery.
Complete procedural success, clinical success and complications of TLE were defined according to the HRS 2009 and 2017 guidelines and the 2018 EHRA expert consensus statement [1,20,21]. Complete procedural success was defined as removal of all targeted leads and material, with the absence of any permanently disabling complication or procedure-related death. Clinical success was achieved in patients with retention of a small part of the lead that did not negatively affect the outcome goals of the procedure [1,20,21].
Major and minor complications were defined according to the 2018 EHRA Expert Consensus Statement on Lead Extraction [21].
Possible technical problems during TLE include: block in lead venous entry / subclavian region, necessity utility of Evolution / TigRail (second line tool in study center), necessity of changing of venous approach for lead extraction (any reasons), impossible utility of lead venous entry approach – procedure (since beginning) using another approach, need to utilise lasso-catheters or basket catheters, extracted lead break and broken lead remnant extraction, extracted lead break and abandonment of broken lead fragment, extracted lead fragmentation – removal in parts, lead to lead strong connection with connecting tissue scar – terrible both leads separation, collapse / fracture of Byrd dilator, dislodgement of functional lead, reeling of ICD lead coil.