title: Transvenous lead extractions: comparison of laser vs. mechanical approach.
abstract: OBJECTIVE
  In this retrospective study we compared different lead extraction techniques.
  
  
  RESULTS
  Between January 2009 and December 2012 we performed transvenous lead extraction procedures on 206 leads in 122 patients. Mean implant duration (MID) was 69.6 months (1-384 months). Leads with lead implant duration ≥ 12 months were assigned to groups according to the extraction technique: Group A: no extraction tool; Group B: laser approach; and Group C: mechanical approach. Overall clinical success was 93.3%. Group A showed a significantly lower MID [38.1 (19-122) months] compared with Groups B and C [83.1 (13-168) months; P < 0.0001 vs. 95.4 (12-384) months; P < 0.0001]. Mean implant duration between Groups B and C did not differ significantly (P = 0.28). Clinical and complete procedural success was 100% in Group A. Clinical success rate was higher in Group C than in Group B (97.0 vs. 76.9%, P = 0.018). Complete procedural success did not differ significantly between Groups B and C (88.9 vs. 76.9%; P = 0.132). In Groups B and C, absence of complete procedural success occurred in long implanted leads (MID 107.8 ± 36.4 and 137.6 ± 89.2 months). Relative costs per extracted lead were 49% higher in Group B than in Group C.
  
  
  CONCLUSIONS
  In case of long implanted leads a laser and a mechanical approach are comparable in complete procedural success and safety. Clinical success and cost effectiveness analysis favours the mechanical approach. Regardless of the extraction technique efficacy and safety optimization has to focus on long implanted leads.
authors.affiliation: Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Christoph T
authors.initials: CT
authors.lastname: Starck
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez
authors.forename: David
authors.initials: D
authors.lastname: Hürlimann
authors.forename: Jürg
authors.initials: J
authors.lastname: Grünenfelder
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Sacha P
authors.initials: SP
authors.lastname: Salzberg
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000191:economics / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007239:Infections / Q000209:etiology; D007834:Lasers; D008297:Male; D019563:Mechanics; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extraction techniques; Extraction tools; ICD; Lead extraction; Pacemaker