title: A novel retrograde laser extraction technique using a transatrial approach: an alternative for complex lead extractions.
abstract: BACKGROUND
  The use of percutaneous lead extraction techniques in a patient with extracardiac or protruding atrial leads could have disastrous consequences. Traditionally, the management of these patients has included a median sternotomy. We describe a minimally invasive technique that involves a transatrial, retrograde laser lead extraction using a video-assisted thoracoscopic approach.
  
  
  RESULTS
  Between January 2004 and June 2009, 14 patients with severed leads at the clavicle and extracardiac leads or lead-caused erosions of the atrial wall were identified through chest radiograph and CT scan. There were 9 men and 5 women aged 19 to 91 years (mean age, 69.71 ± 20.67 years). Ten devices were pacemakers, and 4 were defibrillators. Indications for extraction were 12 infections and 2 malfunctions. Mean ejection fraction was 42 ± 17.67% (range, 10% to 65%). Time of implanted leads was 93.69 ± 51.88 months (range, 33 to 213 months). Laser sheaths size were 12 F (7.1%), 14 F (85.7%), and 16 F (7.1%). A right-side thoracoscopy was performed under general anesthesia. A retrograde laser sheath maneuver was performed, freeing the lead from any adhesions. The lead was removed and the incision closed. One patient experienced a pleural effusion. There was no mortality, and all patients were alive and well at 1-month follow-up.
  
  
  CONCLUSIONS
  - Transatrial, retrograde laser lead extraction is a safe and effective procedure. This procedure may provide an excellent alternative to open sternotomy.
authors.affiliation: Department of Cardiothoracic Surgery, University of Miami Hospital, Miller School of Medicine, Miami, FL, USA.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Juan D
authors.initials: JD
authors.lastname: Garisto
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010138:Pacemaker, Artificial; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D015996:Survival Rate; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome