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Transvenous lead extraction in children with bidirectional rotational dissection sheaths

OBJECTIVES: Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and th...

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Autores principales: Heck, Roland, Peters, Björn, Lanmüller, Pia, Photiadis, Joachim, Berger, Felix, Falk, Volkmar, Starck, Christoph, Kramer, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515391/
https://www.ncbi.nlm.nih.gov/pubmed/37745106
http://dx.doi.org/10.3389/fcvm.2023.1256752
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author Heck, Roland
Peters, Björn
Lanmüller, Pia
Photiadis, Joachim
Berger, Felix
Falk, Volkmar
Starck, Christoph
Kramer, Peter
author_facet Heck, Roland
Peters, Björn
Lanmüller, Pia
Photiadis, Joachim
Berger, Felix
Falk, Volkmar
Starck, Christoph
Kramer, Peter
author_sort Heck, Roland
collection PubMed
description OBJECTIVES: Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited. METHODS: We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements. RESULTS: Twenty-eight children [median age 12.8 (interquartile range 11.3–14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52–102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction (p = 0.006) and complete procedural success (p < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure (p = 0.017). CONCLUSIONS: TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract.
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spelling pubmed-105153912023-09-23 Transvenous lead extraction in children with bidirectional rotational dissection sheaths Heck, Roland Peters, Björn Lanmüller, Pia Photiadis, Joachim Berger, Felix Falk, Volkmar Starck, Christoph Kramer, Peter Front Cardiovasc Med Cardiovascular Medicine OBJECTIVES: Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited. METHODS: We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements. RESULTS: Twenty-eight children [median age 12.8 (interquartile range 11.3–14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52–102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction (p = 0.006) and complete procedural success (p < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure (p = 0.017). CONCLUSIONS: TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract. Frontiers Media S.A. 2023-09-08 /pmc/articles/PMC10515391/ /pubmed/37745106 http://dx.doi.org/10.3389/fcvm.2023.1256752 Text en © 2023 Heck, Peters, Lanmüller, Photiadis, Berger, Falk, Starck and Kramer. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Heck, Roland
Peters, Björn
Lanmüller, Pia
Photiadis, Joachim
Berger, Felix
Falk, Volkmar
Starck, Christoph
Kramer, Peter
Transvenous lead extraction in children with bidirectional rotational dissection sheaths
title Transvenous lead extraction in children with bidirectional rotational dissection sheaths
title_full Transvenous lead extraction in children with bidirectional rotational dissection sheaths
title_fullStr Transvenous lead extraction in children with bidirectional rotational dissection sheaths
title_full_unstemmed Transvenous lead extraction in children with bidirectional rotational dissection sheaths
title_short Transvenous lead extraction in children with bidirectional rotational dissection sheaths
title_sort transvenous lead extraction in children with bidirectional rotational dissection sheaths
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515391/
https://www.ncbi.nlm.nih.gov/pubmed/37745106
http://dx.doi.org/10.3389/fcvm.2023.1256752
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