Academic Journal
Procedural Characteristics and Outcomes of Transvenous Lead Extraction in Patients With Prior Sternotomy.
| Τίτλος: | Procedural Characteristics and Outcomes of Transvenous Lead Extraction in Patients With Prior Sternotomy. |
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| Συγγραφείς: | Mdaihly M; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Demian J; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Younis A; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Hajj J; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Watfa A; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Motairek I; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Tabaja C; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Houmsse MM; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Santangeli P; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Baranowski B; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Taigen TL; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Martin DO; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Kanj MH; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Bhargava M; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Saliba WI; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Hussein AA; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Wazni OM; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Callahan TD; Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: callaht@ccf.org. |
| Πηγή: | JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2026 Jul; Vol. 12 (7), pp. 1672-1680. Date of Electronic Publication: 2026 Mar 05. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101656995 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2405-5018 (Electronic) Linking ISSN: 2405500X NLM ISO Abbreviation: JACC Clin Electrophysiol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [New York, NY] : Elsevier Inc., [2015]- |
| Ιατρικοί όροι (MeSH): | Device Lead Extraction*/adverse effects , Device Lead Extraction*/methods , Device Lead Extraction*/statistics & numerical data , Sternotomy*/adverse effects , Sternotomy*/statistics & numerical data, Postoperative Complications/epidemiology ; Humans ; Female ; Male ; Aged ; Middle Aged ; Treatment Outcome ; Defibrillators, Implantable ; Registries ; Pacemaker, Artificial |
| Περίληψη: | Background: A history of sternotomy has been debated as either a potential protective factor or a possible risk for worse outcomes in patients undergoing transvenous lead extraction (TLE). The safety and efficacy of TLE in this population remain underexplored. Objectives: This study sought to evaluate the impact of prior sternotomy on procedural outcomes in patients undergoing TLE. Methods: Using a prospectively maintained registry, we included all patients undergoing TLE at our center between 1996 and 2022. Patients were categorized into 2 groups based on whether they had a prior sternotomy (PS). Baseline characteristics, procedural outcomes, and safety profiles were compared. Logistic regression was performed to identify independent predictors of major complications. Results: Among 4,846 patients undergoing TLE, 1,344 (27.7%) had a prior sternotomy. These patients had a higher prevalence of comorbidities and an infectious indication for extraction. PS patients experienced significantly lower rates of major complications (1.4% vs 3.0%, P = 0.001), (1.2% vs 2.2%, P = 0.03), and emergent rescue cardiac surgeries (0.7% vs 1.6%, P = 0.011), with higher procedural success rates. On multivariable analysis, PS was independently associated with reduced odds of major complications (OR = 0.52; 95% CI: 0.30-0.89; P = 0.016) and major cardiovascular injury (OR = 0.54; 95% CI: 0.30-0.98; P = 0.043). These findings persisted in a propensity score-matched cohort of 1,256 pairs, confirming significantly lower complication rates in the PS group. Conclusions: Despite exhibiting higher comorbidities, PS patients had fewer major complications during TLE, suggesting a protective effect. Still, the challenges of repeat sternotomy highlight the need for recognizing these patients as high-risk should complications occur. (Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. |
| Contributed Indexing: | Keywords: major cardiovascular injury; major complications; prior sternotomy; transvenous lead extraction |
| Entry Date(s): | Date Created: 20260306 Date Completed: 20260729 Latest Revision: 20260824 |
| Update Code: | 20260825 |
| DOI: | 10.1016/j.jacep.2026.01.039 |
| PMID: | 41790085 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2405-5018 |
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| DOI: | 10.1016/j.jacep.2026.01.039 |