Excimer Laser-Assisted Lead Extraction in 88 High-Risk Patients: A Single-Center Experience

Objectives: Laser-assisted lead extraction is a sophisticated and dangerous procedure, especially in patients with old and multiple leads. High frequency Excimer laser with an 80-Hz pulse repetitive rate was applied routinely in our clinic for pacemaker (PM), implantable cardioverter-defibrillator (ICD) or cardiac contractility modulation (CCM) lead extraction.

Methods: From 03/2011 to 09/2015, 88 consecutive patients (66 males, 65.9 ± 14.4 years) with indication for lead removal were treated with the Excimer laser. All cases were performed in the OR with cardiopulmonary bypass (CPB) standby. Indication for laser removals were endocarditis (17%), pocket infection (40.9%), lead dysfunction (31.8%), valve dysfunction (3.4%) and others (6.8%). Perioperative data including 30-day mortality were analyzed.

Results: A total of 138 leads from 21 pm, 65 ICD and 2 CCM were removed by using the Excimer laser. In average 2.1 ± 1.1 (range: 1–6) device associated procedures were performed prior to the current laser extraction. Mean lead age was 9.0 ± 5.5 years. Mean intervention time was 88 ± 50min. Complete extraction could be achieved in 65.9%, partial removal in 31.8% and no removal in 2.3%. Aggregate explantation was necessary in 65.9%. In detail, one (3.4%), two (54.5%), three (27.3%) and four (3.4%) leads per patient were extracted. During laser procedure, VVI-PM implantation via lateral thoracotomy was performed in 4.5% and CPB was necessary in 5.7%. Thirty-day mortality rate was 4.5%. One patient died from severe hemorrhagic shock by innominate vein laceration later at intensive care unit. Three patients deceased due to septic shock and consecutive multi organ failure.

Conclusion: Excimer laser-assisted lead extraction is a safe and suitable, but highly sophisticated procedure in high-risk patients. Cardiopulmonary bypass standby should be routinely applied in laser-assisted lead extraction. Therefore, it should be performed only in specialized cardiac surgery units.