title: Tricuspid insufficiency after laser lead extraction.
abstract: BACKGROUND
  The use of laser lead extraction (LLE) to remove pacemaker and implantable cardiac defibrillator leads has become more prevalent in the past decade. Though the procedure is associated with a low rate of complications, LLE still poses some risks to patients. Some reports have suggested an increase in tricuspid insufficiency (TI) associated with LLE. We present a series of patients who underwent both LLE and complete evaluation for TI with echocardiographic techniques.
  
  
  METHODS
  From August 2008 to January 2010, 173 prospective, consecutive patients underwent LLE in a single center. All patients had transesophageal echocardiograms (TEE) during the extraction. Fifty-three patients had tricuspid valve function evaluated a day before the procedure with a transthoracic echocardiogram (TTE), during the procedure with a TEE and 2 days postoperatively with a TTE.
  
  
  RESULTS
  All 173 patients experienced no change in tricuspid valve function during the procedure with TEE. Of the 53 patients who underwent a complete TI evaluation, 38 were males (72%) and 15 females (38%), with a mean age of 69.45 ± 14.08. Mean ejection fraction was 35.82 ± 14.72. Three (6%) patients experienced TI after the procedure (two mild and one severe, all with tricuspid valve endocarditis); 16 (30%) patients were found to have TI before LLE that returned to normal valve function during or after the procedure. Thirty-four (64%) patients did not experience any significant change of the tricuspid valve performance after LLE.
  
  
  CONCLUSIONS
  LLE was not associated with increased TI.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. Rodriguy@med.umich.edu
authors.forename: Yasser
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Julian
authors.initials: J
authors.lastname: Mesa
authors.forename: Eric
authors.initials: E
authors.lastname: Arguelles
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
mesh_terms: D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology*
keywords: artificial; implantable defibrillators; intraoperative complications; pacemaker; tricuspid insufficiency