title: The impact of transvenous lead extraction on tricuspid valve function.
abstract: BACKGROUND
  Few data exist regarding the effect of transvenous lead extraction (TLE) on tricuspid valve function. The objective of this study was to examine the effect of TLE on the development of postprocedure tricuspid regurgitation (TR).
  
  
  OBJECTIVE
  To assess the impact of TLE on tricuspid valve function.
  
  
  METHODS
  A single center retrospective analysis of consecutive patients referred for TLE between June 2006 and November 2011. Patients were included only if they underwent transthoracic echocardiography (TTE) before and after lead extraction (N = 124). Patients were assigned a preprocedure and postprocedure TR score on a continuous scale from 0 to 6 (0 = none, 1 = trace, 2 = mild, 3 = mild/moderate, 4 = moderate, 5 = moderate/severe, and 6 = severe). A clinically significant increase in TR was defined as both (1) an increase in TR score of at least two points, and (2) a postprocedure TR score ≥4 (moderate).
  
  
  RESULTS
  A total of 124 patients referred for TLE underwent a TTE both before (9 ±16 months) and after lead extraction (4 ± 8 months). A total of 200 leads (1.6 ± 0.8 per patient) were extracted. The mean change in TR score after lead extraction was +0.18 (95% confidence interval [CI] -0.03 to 0.39, P = 0.11). A clinically significant increase in TR occurred in 7/124 (5.6% [CI 2.3-11.3%]) patients. Age ≥75 (+0.45, [CI 0.07-0.84, P = 0.02]), removal of ≥2 leads (+0.40 [CI 0-0.81, P = 0.05]), and powered sheath-assisted extraction (+0.34 [CI 0.05-0.62, P = 0.02]) were significantly associated with an increase in TR score.
  
  
  CONCLUSIONS
  TLE is rarely associated with the development of clinically significant TR. In our cohort, patient age ≥75 years, pacemaker as opposed to ICD, and removal of ≥2 leads predicted worsening TR.
authors.affiliation: Cardiac Electrophysiology, University of Miami School of Medicine, Miami, Florida.
authors.forename: James O
authors.initials: JO
authors.lastname: Coffey
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Sager
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gangireddy
authors.forename: Avi
authors.initials: A
authors.lastname: Levine
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles-Gonzalez
authors.forename: Avi
authors.initials: A
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D014463:Ultrasonography; D014680:Veins / Q000601:surgery; D055815:Young Adult
keywords: cardiac implantable electronic device; device infection; device malfunction; lead extraction; tricuspid regurgitation; valvular heart disease