Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction.
Injuries to cardiac and venous structures during pacemaker and defibrillator lead extraction are serious complications that have been studied poorly. The incidence of these injuries is unknown but likely underestimated. No systematic multicenter review of these injuries or their management has been undertaken.



We interrogated our mandatory administrative database for all excimer laser extractions that sustained a cardiac or venous injury in the province of British Columbia. Injuries were classified according to presentation and compared with respect to nature of injury, type of repair, utilization of cardiopulmonary bypass, and outcome. Of 1082 excimer laser extractions over 19 years, 33 sustained an injury (3.0%). The majority of injuries occurred in women (21/33; 63.6%), and median age of oldest lead extracted was 10.8 (7.5, 12.2) years. A type 1 presentation, defined as circulatory collapse, was found in 12/33 patients (36.4%). A type 2 presentation, defined as progressive hypotension responsive to treatment, was found in 20/33 patients (60.6%). Over half the patients had a moderate or large injury, and cardiopulmonary bypass was required in 13 patients with extensive injury. Despite the presence of devastating injuries, the immediate availability of aggressive salvage measures resulted in a survival of 87.9% of patients at 30 days.



The immediate availability of a cardiovascular surgeon, perfusionist, and cardiopulmonary bypass pump facilitates lifesaving repair of injuries sustained during laser lead extraction. The size and complexity of injury correlates closely with the presentation, blood loss, and need for cardiopulmonary bypass to facilitate repair.
From the St Paul's Hospital, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (J.B., S.S.K.); Royal Jubilee Hospital, Department of Cardiovascular Surgery, University of Victoria, BC, Canada (L.M.F., J.O.); and Vancouver Coastal Health, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (G.F.O.T.). jmlbashir@gmail.com.
Jamil
J
Bashir
From the St Paul's Hospital, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (J.B., S.S.K.); Royal Jubilee Hospital, Department of Cardiovascular Surgery, University of Victoria, BC, Canada (L.M.F., J.O.); and Vancouver Coastal Health, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (G.F.O.T.).
Lynn M
LM
Fedoruk
From the St Paul's Hospital, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (J.B., S.S.K.); Royal Jubilee Hospital, Department of Cardiovascular Surgery, University of Victoria, BC, Canada (L.M.F., J.O.); and Vancouver Coastal Health, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (G.F.O.T.).
John
J
Ofiesh
From the St Paul's Hospital, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (J.B., S.S.K.); Royal Jubilee Hospital, Department of Cardiovascular Surgery, University of Victoria, BC, Canada (L.M.F., J.O.); and Vancouver Coastal Health, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (G.F.O.T.).
Shahzad S
SS
Karim
From the St Paul's Hospital, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (J.B., S.S.K.); Royal Jubilee Hospital, Department of Cardiovascular Surgery, University of Victoria, BC, Canada (L.M.F., J.O.); and Vancouver Coastal Health, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (G.F.O.T.).
G Frank O
GF
Tyers
D001955:British Columbia; D002315:Cardiopulmonary Bypass; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007834:Lasers; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012042:Registries; D057772:Vascular System Injuries / Q000145:classification* / Q000601:surgery*
cardiac surgery; cardiac tamponade; cardiopulmonary bypass; laser; lead extraction; pacemaker