Uniportal Video-Assisted Thoracotomy during Excimer Laser-Guided Cardiac Implantable Electronic Devices Lead Extraction: A 5-Year Single-Centre Experience

Objectives: Laser-guided extractions of cardiac implantable electronic devices leads have become a routine procedure for lead extraction. Major adverse events such as perforation of the superior vena cava are rare, but often end fatal. In 2014, we introduced a new technique where a concomitant right sided uniportal video-assisted thoracotomy (UVATS) is used during laser-guided lead extraction to prevent and detect massive bleeding before hemodynamic collapse. However, until now, it was not reported whether this technique is safe and feasible. Therefore, we report our 5-year single-center experience in comparison to lead extractions without concomitant UVATS.

Methods: The data from patients undergoing lead extraction in our institution between 2014 and 2019 were analyzed retrospectively. Each patient was evaluated by an experienced surgeon, and decision for concomitant UVATS was made based on age of the leads, type of lead and frailty of the patient. All operations were routinely conducted under general anesthesia and patients were referred to the intensive care unit after the operation.

Result: A total of 71 patients underwent laser guided lead-extraction, and 28 were operated with concomitant UVATS. The baseline characteristics between the two groups did not differ significantly. Neither the X-ray time (620 seconds for UVATS group vs. 746 seconds for non-UVATS group, p = 0.962), length of operation (114 vs. 117 minutes, p = 0.676) or the length of hospital stay (10 vs. 11.3 days, p = 0.990) differed significantly, while patients without UVATS stayed longer on the intensive care unit (0.8 vs. 2.5 days, p = 0.005). No patient in the UVATS group died within 30 days, but 5 patients in the non-UVATS group died, 2 of them due to perforation of the superior vena cava and mass bleeding (p = 0.266). Four patients of the non-UVATS group needed redo operation due to hemothorax, while no patient in the UVATS group developed a hemothorax (p = 0.148). While two patients in the non-UVATS group developed a pneumothorax with indication for chest drain, no such case was recorded in the UVATS group (p = 0.511).

Conclusion: UVATS during laser-guided lead extraction of cardiac implantable electronic devices can be considered as a safe procedure that does not lengthen the operating time or hospital stay and helps to reduce the overall mortality because impending perforations of the superior vena cava or the right atrium can be detected before mass bleeding leads to fatal complications.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021