16-64: multi-center experience with the spectranetics tightrail lead extraction system

INTRODUCTION: Extraction of chronically implanted pacing and defibrillator leads (CLs) can be challenging. There is no one tool or technique that assures a 100% success rate or 0% complication rate. The recently introduced Spectranetics TightRail (TR) extraction sheath is a flexible mechanical tool for dissecting through binding sites and extracting CLs. METHODS: A retrospective review of lead extraction procedures was undertaken at 3 hospitals (A, B and C) over a 21 month period of time since the TR was introduced into the market place. Records were reviewed for lead type, implant duration, age of patient, extraction success, need to use other tools, major adverse events and patient death. Choice of initial technique was left to the physician. Definitions of success and complication are based upon the 2009 HRS consensus statement document. RESULTS: There were 100 patients (A = 47, B = 35 and C = 23) and 147 leads (A = 70, B = 45, C = 31) for whom TR was used. Lead position was RV (N = 98), RA (N = 37) and cardiac vein (N = 12). The duration of lead implant was 10.3 years, and for those whose age was available the average was 63.5 years. 66 leads were ICD leads and 81 were pacing leads. Reason for extraction was advisory (N = 20), infection (N = 65), malfunction (N = 40) and venous access/upgrade/pain/device-not-indicated (22). Complete success rates varied at the 3 centers (A = 84%, B = 98%, C = 90%). There were 2 MAEs, both pericardial tamponade treated with drainage or window), and no deaths. TR was used alone for 66 leads, and in combination with Laser, Cook Evolution, polypropylene and femoral tools for the remainder of the cases. CONCLUSION: The TR extraction sheath enabled removal of relatively old leads without injury to the superior vena cava, and provided a useful additional tool that can be used alone or in combination with other tools to achieve successful extraction of CLs