title: Clinical performance of a new bidirectional rotational mechanical lead extraction sheath.
abstract: OBJECTIVE
  We investigated the safety and efficacy of a new bidirectional rotational mechanical extraction sheath (Evolution RL, Cook Medical, USA).
  
  
  RESULTS
  From April 2013 until September 2014, we performed lead extraction procedures in 71 patients with 112 leads scheduled for extraction. During this time period, we used the new Evolution RL rotational sheath in 40 patients on 52 leads (24 pacemaker leads and 28 implantable cardioverter-defibrillator leads) scheduled for extraction. The mean lead implant duration in these patients was 100.2 (22-271) months. Forty leads were right ventricular leads, 10 right atrial leads, and 2 coronary sinus leads. Clinical success among the leads approached with the Evolution RL device was 98.1%. Operative mortality was zero. Major complications did not occur. Four minor complications were encountered (all pocket haematomas). No device-related complications were noted. In cases with multiple leads in situ, no wrapping of companion leads was seen. The average number of extraction tools used per lead was 2.4 (2-4) in the Evolution RL cohort.
  
  
  CONCLUSIONS
  Based on the presented results of our initial experience with the new bidirectional rotational mechanical extraction device, its use is safe and efficient with high success rates in long implanted leads.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Augustenburger Platz 1, Berlin 13353, Germany starck@dhzb.de ct.starck@me.com ct.starck@web.de.
authors.forename: Christoph T
authors.initials: CT
authors.lastname: Starck
authors.affiliation: Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.affiliation: Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Etem
authors.initials: E
authors.lastname: Caliskan
authors.affiliation: Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tomas
authors.initials: T
authors.lastname: Holubec
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schoenrath
authors.affiliation: Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D062906:Cardiac Catheters; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011474:Prosthesis Design; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ICD; Lead extraction; Pacemaker