title: Post heart transplant extraction of the abandoned fragments of pacing and defibrillation leads: proposed management algorithm.
abstract: BACKGROUND
  An increasing number of patients is referred for orthotopic heart transplantation (OHT) after previous implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT) device implantation.
  
  
  OBJECTIVE
  To assess the rate of unsuccessful lead extractions during OHT and propose an appropriate management algorithm.
  
  
  METHODS
  The study population included 73 consecutive patients who underwent OHT in our hospital between January 2009 and December 2011.
  
  
  RESULTS
  In the study group, 36 (49.3%) patients previously underwent ICD (21 patients, 28.8%) or CRT (15 patients, 20.5%) implantation. In 29 patients, all previously implanted leads were completely removed during transplantation. In 7 (19.5%) patients, fragments of the leads could not be removed and were abandoned due to their adherence to the venous system, including a proximal defibrillation coil in 6 cases and a fragment of a left ventricular lead in 1 case. All abandoned lead fragments were extracted after the transplantation (10-70 days, mean 27 days) either with manual traction techniques (1 case, left ventricular lead), or with the assistance of lead extraction sheaths (6 cases, dual-coil defibrillation leads). Due to lead fracture, it was necessary to use femoral approach in 1 case. No complications of lead extraction were noted.
  
  
  CONCLUSIONS
  In a significant number of patients, previously implanted leads cannot be removed during OHT. Therefore, abandoned lead fragments should be removed after the transplantation using transvenous lead extraction techniques.
authors.affiliation: Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland. k_kusmierski@poczta.onet.pl
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kuśmierski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Przybylski
authors.forename: Artur
authors.initials: A
authors.lastname: Oręziak
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Sobieszczańska-Małek
authors.forename: Piotr
authors.initials: P
authors.lastname: Kołsut
authors.forename: Jacek
authors.initials: J
authors.lastname: Różański
mesh_terms: D000328:Adult; D000465:Algorithms; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D004554:Electric Countershock / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery*; D006321:Heart; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011182:Postoperative Care / Q000379:methods*; D014680:Veins; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging