To grade or not to grade safety requirements for transvenous lead extraction: Experience with 2216 procedures.
long-term survival
organizational model
safety and effectiveness
transvenous lead extraction
Journal
Kardiologia polska
ISSN: 1897-4279
Titre abrégé: Kardiol Pol
Pays: Poland
ID NLM: 0376352
Informations de publication
Date de publication:
2023
2023
Historique:
received:
17
11
2022
accepted:
17
11
2022
medline:
30
3
2023
pubmed:
30
11
2022
entrez:
29
11
2022
Statut:
ppublish
Résumé
Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC). We aimed to assess the impact of TLE organization on the safety of procedures. We analyzed 2216 TLE procedures performed in two centers in the years 2006-2021 and compared three organizational procedural models: (1) TLE in an electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation; (2) TLE with grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, others in EP-LAB); (3) TLE in the hybrid room in all patients under general anesthesia with transesophageal echocardiographic (TEE) monitoring. The safety of procedures and mortality after TLE in three-year follow-up were assessed. The rate of MC in the EP-LAB group was 1.55%, and the rate of procedure-related deaths (PRD) was 0.33%. While using the graded approach to safety requirements, the percentage of MC was 2.61% and PRD 0.29%. When performing TLE procedures in the hybrid room, the MC percentage was 1.33% and PRD 0.00%. Long-term survival after TLE was comparable in all study groups. A key factor in preventing TLE-related deaths is procedure organization that enables emergency cardiac surgery. TLE performed in a hybrid room with a collaborating cardiac surgeon and vital signs monitoring appears to be the safest possible option for the patient. A graded safety approach is associated with the risk of unexpected MC and PRD. Any newly established TLE center can achieve satisfactory results if the optimal organizational model of the procedure is used.
Sections du résumé
BACKGROUND
Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC).
AIMS
We aimed to assess the impact of TLE organization on the safety of procedures.
METHODS
We analyzed 2216 TLE procedures performed in two centers in the years 2006-2021 and compared three organizational procedural models: (1) TLE in an electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation; (2) TLE with grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, others in EP-LAB); (3) TLE in the hybrid room in all patients under general anesthesia with transesophageal echocardiographic (TEE) monitoring. The safety of procedures and mortality after TLE in three-year follow-up were assessed.
RESULTS
The rate of MC in the EP-LAB group was 1.55%, and the rate of procedure-related deaths (PRD) was 0.33%. While using the graded approach to safety requirements, the percentage of MC was 2.61% and PRD 0.29%. When performing TLE procedures in the hybrid room, the MC percentage was 1.33% and PRD 0.00%. Long-term survival after TLE was comparable in all study groups.
CONCLUSIONS
A key factor in preventing TLE-related deaths is procedure organization that enables emergency cardiac surgery. TLE performed in a hybrid room with a collaborating cardiac surgeon and vital signs monitoring appears to be the safest possible option for the patient. A graded safety approach is associated with the risk of unexpected MC and PRD. Any newly established TLE center can achieve satisfactory results if the optimal organizational model of the procedure is used.
Identifiants
pubmed: 36446069
pii: VM/OJS/J/92796
doi: 10.33963/KP.a2022.0266
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
242-251Commentaires et corrections
Type : CommentIn