Ap-452680-3 procedural characteristics and outcomes of transvenous cardiac implantable electronic device system extraction in patients with left ventricular assist device.

Durable LVADs (Left Ventricular Assist Devices) can be prone to infection and the presence of transvenous CIED (Cardiac Implantable Electronic Device) acts as an additional nidus for infection warranting removal of the CIED system. We report the procedural characteristics and outcomes of CIED system extraction in patients with LVAD. A single-center retrospective observational study including all patients with durable LVAD that underwent transvenous CIED extraction at our institution between 2017 and 2022. Twenty patients with LVAD (HeartMate II=14; HeartMate III=6) underwent CIED removal during the study period. Mean age was 52.0 ± 10.1 years and 7 patients had ischemic cardiomyopathy. Ninety percent (18) of extraction were due to infection and 10% (2) were for lead management. Total success (removal of all leads) was achieved in 19 (95%) patients. Overall, 40 out of 45 leads were removed during 21 procedures (Table for lead characteristics). Simple traction was used in 8 patients and specialized extraction tools were used in 12 (Laser sheaths=10; Mechanical rotational sheaths=7; Both=5). No leads were removed in one patient (5 leads; 2-abandoned leads with 42.5 years intravascular dwell time). There were no major procedure related complications. Two minor procedure related complications included a femoral arterial pseudoaneurysm and one pocket revision due to persistent surgical site bleeding. Median follow-up was 17 months (Range 41-323). During follow-up, 7 patients underwent pump-exchange due to persistent infection and 15-remained on chronic suppressive antibiotics. Nine patients died during the follow-up. CIED system extraction is safe and feasible in patients with LVAD with low. procedure-related morbidity and mortality. Long-term outcomes in these patients remain poor despite CIED removal.