Safety and Efficacy of Laser Lead Extraction in Octo- and Nonagenarians: A Subgroup Analysis from the GALLERY Registry

Background: In an aging population with cardiac implantable electronic devices (CIED), an increasing number of octogenarians and even nonagenarians present for lead extraction procedures. Those patients are considered as having an increased risk for surgical procedures including lead extraction. We here investigated in a large patient cohort safety and efficacy of transvenous lead extraction with powered extraction sheaths in octo- and nonagenarians.

Method: A subgroup analysis of the German Laser Lead Extraction Registry (GALLERY) registry was performed. A total of 499 patients aged ≥80 years were included in this analysis. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. Predictors for complications and mortality were evaluated in multivariate analysis.

Results: Mean patients age was 84.3 ± 3.7 years, 27.1% were female. A total of 1,196 leads were treated. The median lead dwell time was 118.0 (78; 167) months. Clinical procedural success rate was achieved in 97.6% of the cases. Procedural failure was observed in 2.1%. Overall complication rate was 4.4%, including 1.8% major and 2.6% minor complications. BMI < 20 was the only statistically significant predictor for procedure related complications. Procedure-related mortality was 0.8%, and all-cause in-hospital mortality was 5.4%. Predictors for in-hospital mortality were systemic infection, BMI ≤20 kg/m², procedural complications and chronic kidney disease.

Conclusion: Laser lead extraction in octo- and nonagenarians is safe and effective. BMI ≤20 kg/m² was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.

Publication History

Article published online:
28 January 2023