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Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction
Author(s) -
Kiani Soroosh,
Sabayon Dean,
Lloyd Michael S.,
Hoskins Michael H.,
ElChami Mikhael F.,
Westerman Stacy,
Vadlamudi Ratna,
Keeling Brent,
Lattouf Omar M.,
Merchant Faisal M.
Publication year - 2019
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13726
Subject(s) - medicine , debulking , percutaneous , lead (geology) , surgery , dialysis , complication , cohort , ovarian cancer , cancer , geomorphology , geology
Background Consensus statements on lead extraction give consideration to open surgical removal in the setting of large vegetations, to mitigate the risk of massive embolism that may occur with percutaneous lead removal. Vacuum‐assisted debulking (VD) of large vegetations as an adjunct to percutaneous lead extraction may provide an opportunity to mitigate these risks. Methods We retrospectively identified all patients undergoing lead extraction at our institution for endovascular infection from 2012 to 2018 and stratified them into two groups based on presence of adjunctive VD (n = 6) or without VD (no‐VD, n = 39). VD was performed with the AngioVac system (Angio‐Dynamics, Latham, NY, USA). Results Across the cohort, mean age was 62 ± 15 years, ejection fraction was 41 ± 16%, and 39% had end‐stage renal disease on dialysis. Defibrillator systems were present in 71%, and 22% had cardiac resynchronization devices. Mean duration of the oldest extracted lead was 6.3 ± 4.9 years. There were no significant differences in baseline covariates between groups. Those in the VD group were significantly less likely to have Staphylococcus aureus as a causative organism ( P = .04). In the VD group, vegetations targeted for debulking ranged in size from 1.8 to 6 cm (longest dimension). There were no operative deaths or clinically evident embolic events in either group. The overall nonfatal complication rate in the VD group was higher (33.3% vs 2.3%, P = .043). Conclusion : VD can be performed as an adjunct to percutaneous lead extraction with a reasonable safety profile. The relative safety and efficacy of this approach removal requires further study.