title: Creation of the sole regional laser lead extraction program serving Atlantic Canada: initial experience.
abstract: BACKGROUND
  An increasing need for laser lead extraction has grown in parallel with the increase of implantation of pacing and defibrillating devices. We reviewed the initial experience of a regional laser-assisted lead extraction program serving Atlantic Canada.
  
  
  METHODS
  We retrospectively reviewed the cases of all consecutive patients who underwent laser lead extraction at the Maritime Heart Centre in Halifax, NS, between 2006 and 2015. We conducted univariate and Kaplan-Meier survivorship analyses.
  
  
  RESULTS
  During the 9-year study period, 108 consecutive patients underwent laser lead extractions (218 leads extracted). The most common indication for extraction was infection (84.3%). Most patients were older than 60 years (73.1%) and had leads chronically implanted; the explanted leads were an average of 7.5 ± 6.8 years old. Procedural and clinical success (resolution of preoperative symptoms) rates and mortality were 96.8%, 97.2%, and 0.9%, respectively. Sternotomy procedures were performed in 3 instances: once for vascular repair due to perforation and twice to ensure that all infected lead material was removed. No minor complications required surgical intervention. Survival after discharge was 98.4% at 30 days and 94% at 12 months.
  
  
  CONCLUSIONS
  Atlantic Canada's sole surgical extraction centre achieved high extraction success with a low complication rate. Lead extraction in an operative setting provides for immediate surgical intervention and is essential for the survival of patients with complicated cases. Surgeons must weigh the risks versus benefits in patients older than 60 years who have chronically implanted leads (> 1 yr) and infection.
authors.affiliation: All authors are from the Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Williams
authors.affiliation: All authors are from the Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS.
authors.forename: Scott
authors.initials: S
authors.lastname: O'Keefe
authors.affiliation: All authors are from the Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Légaré
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data*; D020878:Device Removal / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D016730:Program Development; D012189:Retrospective Studies; D016019:Survival Analysis