title: Explantation of implantable defibrillator leads using open heart surgery or percutaneous techniques.
abstract: BACKGROUND
  To remove failing or infected implantable cardioverter defibrillator leads, percutaneous techniques and open heart surgery are two common approaches. However, well-defined indications for either technique are not available. We summarize our experience with implantable cardioverter defibrillator system explantation using open heart surgery and percutaneous lead removal.
  
  
  METHODS
  A total of 1,391 transvenously introduced implantable cardioverter defibrillator systems were implanted during the analyzed time interval from January 1995 to June 2005 in our institution. In 21 patients (1.5%), open heart surgery for implantable cardioverter defibrillator lead and generator explantation was applied (group A), and in 53 patients (3.8%), a percutaneous lead removal was possible (group B). The log-rank test was used to calculate differences in survival between both patient groups, and the Student's t test was applied for differences in nonlethal complications.
  
  
  RESULTS
  The 30-day, 6-month, 12-month, and 5-year survival rates were 91%, 91%, 81%, and 71%, respectively, for group A patients, and 100%, 100%, 94%, and 78%, respectively, for group B patients, which was not statistically different (p = 0.11). After open heart surgery, survival was comparable for cases with lead removal because of lead infection and those with lead malfunction (p = 0.28); however, patients with open heart surgery had a longer hospital stay (p = 0.03). Student's t test revealed no statistical difference in nonlethal complications between both patient groups (p = 0.37).
  
  
  CONCLUSIONS
  As open heart surgery yielded similar results with regard to survival and complications, implantable cardioverter defibrillator lead removal using extracorporeal circulation may be well justified as a last therapeutic option, eg, in case of large bacterial vegetations.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital, Muenster, Germany. dcamboni@arcor.de
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Christian G
authors.initials: CG
authors.lastname: Wollmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Löher
authors.forename: Rainer
authors.initials: R
authors.lastname: Gradaus
authors.forename: Hans Heinrich
authors.initials: HH
authors.lastname: Scheld
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods; D016022:Case-Control Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome