Long-term outcomes of prophylactic placement of an endovascular balloon in the vena cava for high-risk transvenous lead extractions

Heart Rhythm. 2017 Dec;14(12):1833-1838. doi: 10.1016/j.hrthm.2017.08.003. Epub 2017 Aug 7.

Abstract

Background: Many clinicians use the strategy of prophylactically placing an endovascular balloon before transvenous lead extraction, yet there are no data regarding this practice.

Objective: This study assesses long-term outcomes of prophylactic placement of an endovascular balloon in the venae cavae of patients during transvenous lead extraction.

Methods: From April 1, 2016 to March 31, 2017 data were prospectively collected at 2 international cardiovascular centers on patients who had the balloon prophylactically placed in the venae cavae. Patients were monitored for a minimum of 3 months to capture any associated adverse events.

Results: Twenty-one patients had the balloon prophylactically placed in the venae cavae during lead extraction. Sixteen patients were male (76%); the mean age was 57.6 ± 18.7 years; and the mean body mass index was 26.1 ± 4.4 kg/m2. The mean lead dwell time was 11.2 ± 8.3 years, with an average of 2.2 ± 1.1 leads per case, and most indications for extraction were noninfectious (62%). Two minor complications (10%, pocket hematomas) and 1 major complication (5%, cardiac tamponade) occurred during the procedure. All cases (100%) were procedural successes, and all patients (100%) were discharged alive. On follow-up (6.8 ± 3.7 months), all patients were alive and reported no adverse events related to prophylactic balloon placement, such as pulmonary emboli or deep venous thrombi.

Conclusion: During the study period, we observed no acute or long-term adverse outcomes associated with prophylactic placement of an endovascular balloon in the venae cavae of patients undergoing transvenous lead extraction.

Keywords: Bridge; Endovascular balloon; Long-term outcomes; Prophylactic placement; Transvenous lead extraction.

Publication types

  • Multicenter Study

MeSH terms

  • Catheterization, Peripheral / adverse effects*
  • Defibrillators, Implantable / adverse effects*
  • Device Removal / adverse effects*
  • Endovascular Procedures / methods*
  • Equipment Design
  • Female
  • Fluoroscopy
  • Follow-Up Studies
  • Germany / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / prevention & control*
  • Retrospective Studies
  • Risk Factors
  • Surgery, Computer-Assisted / methods*
  • Time Factors
  • United States / epidemiology
  • Venae Cavae