Single center experience in transvenous lead extraction and management of tricuspid valve disease

The impact of Cardiac Implantable Electronic Devices’ (CIED) lead management on tricuspid valve disease (TVD) is an emergent topic. We report our single center experience on transvenous lead extraction (TLE) performed for tricuspid valve disease (TVD), the subsequent CIED management post-TLE and TVD therapy post-TLE. All consecutive patients from January 2021 to August 2022 who underwent TLE for TVD management were retrospectively included. Trans-thoracic (TTE) and/or trans-esophageal echocardiography (TEE) was performed to assess TVD severity pre- and post-TLE. A total of 30 patients were included (mean age 70 years, 16 (53%) women) with a total of 51 leads. TLE indication was severe tricuspid regurgitation (TR) in all patients except one with severe tricuspid stenosis and mild TR. TVD was developed on native valve in 25 patients (83%), on bioprosthetic tricuspid valve replacement (TVR) in 3 patients (10%) and on tricuspid valve repair in 2 patients (7%). Complete TLE was achieved for 50 leads (98%) except for one abandoned Riata lead (Abbott, Chicago, IL) which was extracted during the surgical TVR post TLE. No TLE procedure-related death or pericardial effusion were reported. TR was not improved post-TLE except for 1 patient. Post-TLE, 11 patients (37%) underwent a surgical bioprosthetic TVR, 2 patients (7%) a surgical repair, 3 patients (10%) a percutaneous TVR and 9 patients (30%) a transcatheter edge to edge repair (Triclip). 26 patients (87%) had a significant TR improvement on TTE and/or TEE after the TVD procedures. 4 patients (13%) didn’t undergo any tricuspid procedure post-TLE, 2 of them died early after TLE due to terminal multi-organ failure, 1 patient had significant TR improvement after CRT TLE and 1 patient was kept on medical treatment due to high-risk procedure. 26 patients (87%) had CIED reimplantation at the time of TLE with 24 (83%) leadless pacemaker, 1 (3%) sub-cutaneous ICD (S-ICD), 1 (3%) with both devices. 4 patients (13%) were planned for epicardial pacemaker at the time of tricuspid surgery, but one patient died before. Atrial leads were preserved in 4 patients (13%) allowing Triclips in 3 patients and TVR in 1 patient. TLE is feasible and can improve TVD only if followed by tricuspid procedure therapy. A multidisciplinary approach for patients with TVD and CIED is crucial to carry out this complex issue with multi-step management composed of TLE, CIED reimplantation and subsequent tricuspid valve management.