ABSTRACT
Background and aims : Transvenous lead extraction (TLE) has
become a pivotal part of a comprehensive lead management strategy,
dealing with a continuously increasing demand. Nonetheless, literature
about the long-term impact of TLE on survivals still lacking. Given
these knowledge gaps, the aim of our study was to analyse very long-term
mortality in patients undergoing TLE in public health perspective.
Methods : This prospective, single-centre, observational study
enrolled consecutive patients with cardiac implantable electronic device
(CIED) who underwent TLE, from January 2005 to January 2021. The main
goal was to establish the independent predictors of very long-term
mortality after TLE. We also aimed at assessing procedural and
hospitalization related costs.
Results : We enrolled 435 patients (mean age 70 ± 12 years, with
mean lead dwelling time 6.8 ± 16.7 years), with prevalent infective
indication to TLE (92%). Initial success of TLE was achieved in 98% of
population. After a median follow-up of 4.5 years (range 1 month- 15.5
years),150 of the 435enrolled patients (34%) died. At multivariate
analysis, death was predicted by: age (≥ 77 years, OR: 2.55, CI:
1.8-3.6, p<0.001), chronic kidney disease (CKD)defined as
severe reduction of estimated glomerular filtration rate (eGFR
<30 mL/min/1.73m2, OR:1.75, CI: 1.24-2.4, p=0.001), systolic
dysfunction assessed before TLE defined as left ventricular ejection
fraction (LVEF) <40%, OR:1.78, CI 1.26-2.5, p=0.001). Mean
extraction and reimplantation-related costs were \euro5989 per
procedure.
Conclusions : Our study identified three predictors of long-term
mortality in a high-risk cohort of patients with a cardiac device
infection, undergoing successful TLE. The future development of a
mortality risk score before might impact on public health strategy.