title: Hybrid Minimally Invasive Approach for Transvenous Lead Extraction: A Feasible Technique in High-Risk Patients.
abstract: BACKGROUND
  Despite the overall safety, transvenous lead extraction (TLE) remains a challenging procedure with inherent risks, where surgery can still be required in elective cases. In this study, we report our experience with a minimally invasive "hybrid" approach, defined as a procedure performed by an electrophysiologist with the support of a cardiac surgeon in the same operative session.
  
  
  RESULTS
  We reported 12 cases of planned hybrid lead extraction; minithoracotomy and thoracoscopy were performed on 10 (83%) and 2 (17%) patients, respectively. A total of 25 leads out of 27 (median lead age 19 years) were successfully extracted with laser, mechanical or combined transvenous sheath. In 3 patients, the direct monitoring of vascular and myocardial integrity allowed for prompt treatment of potential vascular injury during the lead extraction maneuvers. Mean in-hospital stay was 4 ± 2 days. There were no major intraoperative complications and no deaths occurred after 30 days' follow-up.
  
  
  CONCLUSIONS
  The hybrid approach, with minithoracotomy or thoracoscopy, is feasible and it might increase the safety in the most challenging TLE procedures: the minimally invasive surgical intervention allows for continuous monitoring of the critical cardiac structures and prompt treatment of potential complications.
authors.affiliation: Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bontempi
authors.affiliation: Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vassanelli
authors.affiliation: Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cerini
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bisleri
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Repossini
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Giroletti
authors.affiliation: Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Inama
authors.affiliation: Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Salghetti
authors.affiliation: University of Catania, PO Ferrarotto, Catania, Italy.
authors.forename: Daria
authors.initials: D
authors.lastname: Liberto
authors.affiliation: Clinical Research, Biotronik Italia, Milano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Giacopelli
authors.affiliation: Cardiac Surgery Department, L.U.de.S. University, Lugano, Switzerland.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Raweh
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Muneretto
authors.affiliation: Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices; D000072096:Cardiologists; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010138:Pacemaker, Artificial; D010348:Patient Care Team; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D066231:Surgeons; D013906:Thoracoscopy / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
keywords: implantable cardioverter defibrillator; lead extraction; minimally invasive thoracotomy; pacemaker; thoracoscopy