title: Evaluation of tricuspid valve regurgitation following laser lead extraction†.
abstract: OBJECTIVE
  The objective of this study was to examine the effect of laser lead extraction (LLE) on the development of post-procedural tricuspid regurgitation (TR). Some reports have suggested an increase in TR associated with LLE. We present a series of patients who underwent both, LLE and complete echocardiographic evaluation for TR.
  
  
  METHODS
  A single centre analysis of consecutive patients referred for LLE between January 2012 and August 2015. One hundred and three patients had tricuspid valve function evaluated before the procedure with a transthoracic echocardiography (TTE), during the procedure using transoesophageal echocardiography and postoperatively using a TTE. TR was graded from 0 (none) to 4 (severe).
  
  
  RESULTS
  We treated 235 leads in 103 patients, including 118 ventricular leads. Seventy-seven were male (74.8%) and 26 female (25.2%), with a mean age of 65.6 ± 15.4 years. Mean time from initial lead implantation was 98.0 ± 67.3 months. Twenty-one patients (20.4%) had ejection fraction below 30%. No intra-procedural worsening of tricuspid valve function was seen with TEE in any of the patients. Ten patients (9.7%) were found to have TR before LLE that returned to normal valve function after the procedure. Two patients (1.9%) experienced mild TR after the procedure (both with tricuspid valve endocarditis). Ninety-one patients (88.3%) did not experience any significant change of the tricuspid valve function after LLE.
  
  
  CONCLUSIONS
  Transthoracic and transoesophageal echocardiography findings showed that laser lead extraction was not associated with a significant increase in the incidence of tricuspid valve regurgitation.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Pecha
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Liesa
authors.initials: L
authors.lastname: Castro
authors.affiliation: Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Gosau
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Linder
authors.affiliation: Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Vogler
authors.affiliation: Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Samer
authors.initials: S
authors.lastname: Hakmi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects / Q000706:statistics & numerical data; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology
keywords: High frequency laser sheaths; ICD lead extraction; Laser lead extraction; Pacemaker lead extraction; Tricuspid regurgitation