title: Extraction of transvenous leads in the operating room versus electrophysiology laboratory: a comparative study.
abstract: BACKGROUND
  Although risks and life-threatening complications associated with lead extraction are well characterized, practice patterns vary regarding whether procedures are performed in an operating room (OR) or electrophysiology (EP) laboratory with cardiothoracic surgical backup.
  
  
  OBJECTIVE
  Our objective was to compare procedural outcomes and complications associated with lead extraction in the OR vs. EP laboratory.
  
  
  METHODS
  Prospectively acquired data were pooled from 2 referral centers. Lead extraction procedures were performed between 2000 and 2010, encompassing a transition phase from the OR to EP laboratory. Analyses were conducted using generalized estimating equations.
  
  
  RESULTS
  A total of 1,364 leads (533 OR; 831 EP laboratory) were targeted in 684 consecutive procedures, 41.2% of which were in the OR. Laser sheaths and snares were used for 699 (51.2%) and 101 (7.4%) leads, respectively. Overall, 775 (93.1%) vs. 487 (91.4%) leads were completely extracted in the EP laboratory vs. OR [odds ratio 1.3, 95% confidence interval 0.9 to 2.1]. Complications occurred in 2.24% vs. 2.84%, respectively (P = .431). Two patients died because of superior vena caval lacerations (0.29%), 1 in each group. Rapid surgical intervention was helpful in 6 (0.9%) patients [4 OR (2 subclavian vein lacerations, 1 tricuspid valve laceration, 1 tamponade); 2 EP laboratory (tamponades)], with subsequently favorable outcomes. The only independent predictor of complications was older lead age [odds ratio 1.11 per year, 95% confidence interval 1.02 to 1.20].
  
  
  CONCLUSIONS
  Lead extraction in the EP laboratory with surgical backup is associated with a similarly low rate of complications and mortality as procedures performed in the OR.
authors.affiliation: Department of Cardiology, University Hospital La Timone, Marseilles, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Franceschi
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Linda
authors.initials: L
authors.lastname: Koutbi
authors.forename: Sébastien
authors.initials: S
authors.lastname: Prévôt
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D016001:Confidence Intervals; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009873:Operating Rooms; D010138:Pacemaker, Artificial; D011446:Prospective Studies