1256Monitoring of TLE procedure using TEE does it influences for procedure efficacy ? The comparison of two large populations (1058 and 2068 patients)

Abstract Background To improve safety of lead extraction monitoring by using continuous TEE was proposed and introduced recently (after the introduction of cardiac surgeon presence, optimal venue such as hybrid room, arterial line etc). However, until now it is not proved that it works in practice. Objective The goal of this study was to compare TLE effectiveness and safety between two large group with TLE performed with and without TEE monitoring. Methods During last 15 years 3126 TLE were performed; 5183 leads (1-6 leads, aver 1,65, with mean implant duration time 95,7 mth) were extracted using - as first line - non-powered mechanical tools. Results In spite of the fact that the group which was monitored with TEE was sicker (Carlson’s index, lower EF), had more TLE risk factors (implant duration) and TLE procedure was much more difficult (more technical problems) – the TLE effectiveness was better (more radiological, clinical and procedural success, less partial radiological success) and major complications was even slightly less frequent. Unexpected differences in mid-term mortality can be explained by different rate of infective indications or lead remnant influence. Conclusions Results seem to indicate favourable effects of utility TEE for TLE procedure monitoring. Abstract Figure. </jats:sec

P1181Lead dependent tricuspid dysfunction- mechanism and treatment

Abstract Background Lead dependent tricuspid dysfunction (LDTD) is  a hardly recognizable severe complication of permanent cardiac pacing. Purpose Aim of the study was to assess the mechanism of lead dependent tricuspid dysfunction (LDTD) and effect of transvenous leads extraction (TLE) in theese patients. Methods We analyzed the clinical data of 3110 patients undergoing TLE from 01/2006 to 09/2019 in a single center. Echocardiographic assessment  was performed in 2559 patients. LDTD mechanism and improvement of valve function after unblocking (by removing the lead) were analyzed. Results LDTD was recognized in 98 (7,3%) patients. The most common mechanism of LDTD was pulling up the leaflet of tricuspid valve by the lead. Improvement of tricuspid valve function was observed in all patients with recognized LDTD. 18 patients with slight improvement were directed to cardiosurgery after TLE. Conclusions LDTD should be considered in patients with implanted pacing system and severe tricuspid regurgitation. Transvenous leads extraction can improve function of tricuspid valve in theese patients. Abstract Table </jats:sec

P1504Monitoring of TLE procedure using TEE practical utility Experience from 927 procedures

Abstract Background Monitoring of the process of transvenous lead extraction using continuous TEE was delivered for the purpose of earlier recognition of cardiac or venuos wall tear  (behind hemodynamic and respiratory monitoring etc). But our experience indicates that it may be providing much more very important information for operator about present occurrences invisible for fluoroscopy monitoring and to warm about threatening disaster. Objective The goal of this study was to describe frequency of menaces visible in TEE before after effects will reveal. Methods  During last 4,5 years 1019 TLE were performed but due to different reasons complete TEE monitoring was performed in 910 patients; 1705 leads (1-4 leads, aver 1,66, with mean implant duration 100,7 mth) were extracted using as first line non-powered mechanical tools. There were 20 major complications (2,0%) but no procedure related death. We obtained 98,7% procedural and 97,9% clinical success. Results are presented in the table. Conclusions TEE cautioned about dangerous poling or torsion of the heart structures and permitted immediate explanation of the reasons of drop of blood pressure, brought information about arising cardiac tamponade, about rapid blood clothing in epicardial space and the onset of cave-in RV wall before significant drop of blood pressure. Uncomplicated course after rescue sternotomy seems be result of timeous it execution. Abstract Figure. </jats:sec

P2854Floating connecting tissue scars ghosts after transvenous lead extraction

Abstract Background The phenomenon of appearance of connecting tissue remnants floating in vena cava (VC), right atrium (RA) tricuspid valve (TV), right ventricle (RV) or coronary sinus (CS) was described recently. Frequency of occurrence and their significance remain unknown. Till now, our knowledge is limited due lack exact description in the literature. Purpose The goal of this study was analysis of the appearance of this phenomenon using trans-esophageal echocardiography. Methods Between 2006 and January 2018 we performed 2408 TLE procedures using conventional mechanical sheaths. 3836 leads (mean implant duration 96,13 months) were extracted, mainly due to non-infective indications in 64,2%. Results of exact TEE before and after the procedure were available in 2034 patients. All patients with incomplete ECHO/TEE evaluation were excluded from the analysis. Results Results are presented in the table Conclusions In about 25% of patients after TLE floating connecting tissue scars can be observed. Most frequently they can be noted in VC (33%) RA (28%) and RV (10%). In 23% ghosts has numerous location in different combinations. Mean size of “ghosts” is about 20x4 mm. This phenomenon should be known for doctors who perform transesophageal echocardiography to avoid faulty diagnosis. </jats:sec

P1182Asymptomatic masses on the pacing leads - influence on long term survival

Abstract Background Asymptomatic Masses on Endocardiac Leads  (AMELs) are relatively often found in echocardiography in patients with cardiac implantable electronic devices (CIED) but their clinical significance is unknown. Purpose Aim of the study was to evaluate the incidence of AMELs and assesment of their influence on long term survival (mean follow up- 4,28 ± 3,13 years) of patients undergoing transvenous leads extraction (TLE). Methods We analyzed the clinical data of patients undergoing TLE in single center in years 2006-2019. Echocardiography before TLE was performed in 2558  patients (60,4% male). AMELs were detected in 426 (16,7%) cases. Classifications of AMELs included connective tissue surronding the leads, clots, alike vegetations masses.  Additionally, real vegetations, thickening of the leads and strong connective tissue scars were distinguished. Long term survival was compared between individual types of AMELs and patients without any additional masses on the leads. Results are presented in the table. Conclusion Poor long-term survival was observed in patients with AMELs on the pacing leads. Abstract Table </jats:sec

The role of cardiac surgery in transvenous lead extraction (TLE) – experience from high volume center and 3207 procedures

Abstract Background The guidelines suggest close co-operation between TLE operating team and cardiac surgery and its key role in the management of life-threatening complications remains unquestionable. But the role of cardiac surgeon seems to be much more extended. Purpose We have analysed the role of cardiac surgery in treatment of patients undergoing TLE procedures. Methods Using standard non-powered mechanical systems we have extracted ingrown PM/ICD leads from 3207 pts (38,7% female, average age 65,7-y) during the last 14 years. Non-infectious TLE indications were in 66,4% of patients. 46% had PM DDD system, 19% PM SSI, 22% ICD, 9% CRT, 4% other systems. In 12% of patients abandoned leads were found. 8% of patients had one lead, 54% - two, 15% - three and 4% - 4–6 leads in the heart. An average dwell time of all leads was 91,5 mth. The lead entry side was left in 96% of patients, right in 3% and both – 4%. Results Procedural success 96,1%, clinical success - 97,8%, procedure-related death 0,2%. Major complications appeared in 1,9% (cardiac tamponade 1,2%, haemothorax 0,2%, tricuspid valve damage 0,3%, stroke, pulmonary embolism &amp;lt;1%). Conclusions Rescue cardiac surgery (for severe haemorrhagic complications) is still the most frequent reason of surgical intervention (1,1%). The second area of co-operation includes supplementary cardiac surgery after (incomplete) TLE (0,8%). The third one is connected with reconstruction or replacement of tricuspid valve, which can be affected by ingrown lead or damaged during TLE procedure (0,5%). Implantation of the complete epicardial system during any surgical intervention (rescue or delayed) should be considered as a supplementation of the operation (0,65%). Some of patients after TLE need implantation of epicardial leads for permanent epicardial pacing (0,6%) and some only left ventricular lead to rebuild permanent cardiac resynchronisation (0,5%). The single experience of large TLE centre indicates the necessity of close co-operation with cardiac surgeon, whose role seems to be more comprehensive than a surgical stand-by itself. Table 1 Funding Acknowledgement Type of funding source: None </jats:sec

Repeated lead extraction – the new challenge. Experience from 3207 TLE procedures

Abstract Background Transvenous lead extraction (TLE) is optimal option of management of lead-related problems. Usually the procedure has favourable long-term effect. Most of patients get the new or restored pacing system and risk of following lead-related problems may occur again. The knowledge about re-extraction procedures is limited. Methods In high volume centre during the last 15 years 3207 TLE procedures were performed and 1–6 leads (aver 1,65, with mean oldest implant duration 96,6 mth) were extracted using as first line non-powered mechanical tools. Other tools were used if necessary. We analysed data of first TLE procedures and repeated extractions. Results Are presented in the table. Re-extractions include 4,3% of all TLE procedures. Re-infection is less frequent reason for re-extraction (26,8%). Most re-extractions were performed because of dysfunction or damage of lead, which was newly implanted (56) or preserved during previous TLE (20). The last one indicates, that during TLE procedure it should be considered to replace all existing leads, not only these damaged or dysfunctional. Conclusion Re-extractions are safe procedures with very good results. Previously performed extraction is not a risk factor for another TLE procedure. Re-extraction should not be avoided in lead management strategy. Table 1 Funding Acknowledgement Type of funding source: None </jats:sec

P3135Tricuspid valve dysfunction caused by transvenous lead extraction. Can we predict this complication?

Abstract Background Accidental damage of tricuspid apparatus is known complication of TLE procedure risk factors of this complication remain unknown. Purpose The goal of this study was to search factors which can predict damage of tricuspid apparatus during TLE. Methods Between 2006 and 2018 we performed 2002 TLE procedures using conventional mechanical sheaths. 3366 leads (mean implant duration 95,2 months) were removed due to non-infective indications in 62,0%. Tricuspid valve function was examined with preoperative and post-operative TTE and during monitoring of procedure. Patients with incomplete TV function evaluation were excluded from the study. Three groups of patients were compared Results TLE procedure brings risk (7%) of different degree damage or tricuspid leflet or even chordae tendinae (2%). The detailed results are presented in the table. Conclusions TLE using conventional mechanical sheaths is effective but brings risk of extraction related tricuspid valve dysfunction. Main risk factor of this complication seems to be implant dwell time, number of leads presence of abandoned leads and lead loop in the heart remaining in conflict with tricuspid valve. </jats:sec

2407Influence of transvenous lead extraction procedure on function of tricuspid apparatus

Abstract Background Accidental damage of tricuspid apparatus remain known complication of TLE procedure but our knowledge is limited due lack of separate analysis in the literature. Purpose The goal of this study was analysis of the appearance of lead extraction related tricuspid valve dysfunction using trans-chest and trans-oesophageal echocardiography. Methods Between March 2006 and December 2018 we performed 2900 TLE procedures using conventional mechanical sheaths in 1760 male and 1140 female patients (mean age 66.6y). 4811 leads (mean implant duration 91.5 months) were removed due to non-infective indications in 65.3%. Full radiological success was obtained in 95.7% procedures, partial in 4.0%, clinical success in 98.0%, full procedural success in 96.1%. Major complications (MC) appeared in 8 (1.8%). Results Results are presented in the table Conclusions TLE using conventional mechanical sheaths is effective. Tricuspid valve dysfunction different degree is frequent finding in candidates for TLE. TLE procedure brings risk (7.2%) of different degree damage of tricuspid leflet (significant in 1.5%) or even chordae tendinae (4%). Patients with severe lead extraction related tricuspid valve dysfunction needs exact follow-up and some of them can be candidates for cardiac surgery. On the other hand in not so rare cases of lead related tricuspid valve dysfunction – lead removal/replacement can to bring improvement of tricuspid valve function (6.1%). </jats:sec