title: Outcomes and costs associated with two different lead-extraction approaches: a single-centre study.
abstract: OBJECTIVE
  We sought to compare outcomes and costs of a stepwise approach to transvenous lead extraction (TLE) involving laser-assisted sheaths or mechanical polypropylene sheaths, with/without crossover.
  
  
  RESULTS
  We prospectively included patients who underwent TLE (between August 2013 and December 2014) as part of a stepwise approach involving simple traction, lead snaring, and sheath-assisted dissection; all of these patients underwent a first-line polypropylene-sheath-extraction approach (Group A). The comparison group (Group B) was consecutive patients who had undergone TLE before August 2013, during which laser-assisted sheath extraction was the first-line approach. The number of patients in Group B was adjusted to match the number who eventually needed sheaths in Group A. Procedural data, outcomes, and costs were compared between groups (comparison of approaches) and in patients who needed sheath-assisted extraction (comparison of techniques). Overall, 521 leads were extracted (131 patients in Group A, 104 in Group B). Radiological and clinical success rates were similar; crossover from polypropylene to laser sheaths was needed in 10 patients in Group A (vs. none in Group B). Radiological (P< 0.001) and clinical (P= 0.01) success rates were higher and were achieved with a lower radiation exposure (P= 0.03) with laser sheaths in patients (60 in each group) who needed sheath-assisted extraction. Complication rates were similar in both groups (P= 0.66) but two deaths occurred in Group B. The laser approach had higher material cost (P= 0.002).
  
  
  CONCLUSIONS
  Although laser-assisted TLE was more effective than polypropylene sheath-assisted TLE, the latter was associated with fewer complications and was more cost-effective.
authors.affiliation: Service de Cardiologie-Rythmologie, CHU la Timone, Marseille 13385, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Gaubert
authors.affiliation: Aix-Marseille Université, UMR_S 912 (SESSTIM), IRD, Marseille 13385, France.|INSERM, UMR_S 912 (SESSTIM), Marseille 13385, France.|APHM, hôpital Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille 13005, France.
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.affiliation: Service de Cardiologie-Rythmologie, CHU la Timone, Marseille 13385, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Franceschi
authors.affiliation: Service de Cardiologie-Rythmologie, CHU la Timone, Marseille 13385, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Koutbi-Franceschi
authors.affiliation: Service de Cardiologie-Rythmologie, CHU la Timone, Marseille 13385, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Gitenay
authors.affiliation: Service de Cardiologie-Rythmologie, CHU la Timone, Marseille 13385, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Maille
authors.affiliation: Service de Cardiologie-Rythmologie, CHU la Timone, Marseille 13385, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D062906:Cardiac Catheters / Q000191:economics; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000009:adverse effects; D020878:Device Removal / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D005602:France; D017048:Health Care Costs; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D011126:Polypropylenes / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics*; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000191:economics; D015641:Radiography, Interventional / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes
keywords: Cardiac implantable electronic devices; Costs; Laser sheath; Outcomes; Polypropylene sheath; Transvenous lead extraction