title: Cardiopulmonary bypass standby avoids fatality due to vascular laceration in laser-assisted lead extraction.
abstract: OBJECTIVE
  Vascular laceration is a rare but potentially fatal complication with excimer laser-assisted pacemaker or implantable cardioverter-defibrillator lead extraction. We report our experience on management of vascular laceration during laser-assisted lead extraction.
  
  
  METHODS
  We retrospectively reviewed 140 consecutive patients undergoing laser-assisted lead extraction from May 2004 to March 2011. Clinical outcomes were compared in patients with and without intraoperative vascular laceration. Risk factors were identified by multivariate logistic regression.
  
  
  RESULTS
  All cases were performed in the operating room with cardiopulmonary bypass standby. Complete lead removal was achieved in 118 (84.3%) patients. Potentially fatal complications occurred in five patients (3.6%) who had superior vena cava and/or innominate vein laceration. Lacerated veins were repaired under emergency sternotomy and cardiopulmonary bypass. The mean time from vascular laceration to establishment of cardiopulmonary bypass was 6.0 ± 3.6 minutes. All five patients survived without neurological sequelae. The rates of dual-coil leads (80.0% vs. 31.9%, p=0.025) and history of lead revision (100.0% vs. 40.0%, p=0.008) were significantly higher in the five patients who had major vascular laceration than those who did not. Logistic regression showed that dual-coil implantable cardioverter-defibrillator lead was an independent risk factor for vascular laceration (odds ratio 11.264, p=0.048).
  
  
  CONCLUSIONS
  Cardiopulmonary bypass standby is helpful when performing laser-assisted lead extraction to treat potentially fatal vascular laceration. Dual-coil lead is an independent risk factor to predict intraoperative vascular laceration.
authors.affiliation: Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Wang
authors.forename: Dennis
authors.initials: D
authors.lastname: Modry
authors.forename: Shaohua
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000293:injuries / Q000601:surgery; D002315:Cardiopulmonary Bypass; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods; D004630:Emergencies; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D054018:Lasers, Excimer / Q000009:adverse effects* / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D014683:Vena Cava, Superior / Q000293:injuries / Q000601:surgery