Cardiopulmonary bypass standby avoids fatality due to vascular laceration in laser-assisted lead extraction.

OBJECTIVES

Vascular laceration is a rare but potentially fatal complication with excimer laser-assisted pacemaker or implantable cardioverter-defibrillator lead extraction. We report our experience on management of vascular laceration during laser-assisted lead extraction.

METHODS

We retrospectively reviewed 140 consecutive patients undergoing laser-assisted lead extraction from May 2004 to March 2011. Clinical outcomes were compared in patients with and without intraoperative vascular laceration. Risk factors were identified by multivariate logistic regression.

RESULTS

All cases were performed in the operating room with cardiopulmonary bypass standby. Complete lead removal was achieved in 118 (84.3%) patients. Potentially fatal complications occurred in five patients (3.6%) who had superior vena cava and/or innominate vein laceration. Lacerated veins were repaired under emergency sternotomy and cardiopulmonary bypass. The mean time from vascular laceration to establishment of cardiopulmonary bypass was 6.0 ± 3.6 minutes. All five patients survived without neurological sequelae. The rates of dual-coil leads (80.0% vs. 31.9%, p=0.025) and history of lead revision (100.0% vs. 40.0%, p=0.008) were significantly higher in the five patients who had major vascular laceration than those who did not. Logistic regression showed that dual-coil implantable cardioverter-defibrillator lead was an independent risk factor for vascular laceration (odds ratio 11.264, p=0.048).

CONCLUSION

Cardiopulmonary bypass standby is helpful when performing laser-assisted lead extraction to treat potentially fatal vascular laceration. Dual-coil lead is an independent risk factor to predict intraoperative vascular laceration.