4.) Peri- and post-operative findings
Perioperative data showed the highest proportion of patients requiring stimulation (75%) in the EL group, with a high proportion in the SI group, while no patient required stimulation in the SR group. Operating times varied depending on the surgical complexity, with the shortest operation times in the SR group. Extraction procedures in all groups relied on the use of specialized extraction devices such as the excimer laser (46.6-67.9%) or mechanical rotational extraction sheaths (7.1-12.3%) in more than 50% of cases. On average, between 2.3 and 2.6 electrodes were removed per patient, with 93.2 to 96.4% complete success rate. Existing lead vegetations were removed with an efficacy of 94.1% (EL) to 100% (SI). Approximately one-quarter of SR and EL patients received a wearable cardioverter defibrillator (WCD) for bridging until ICD re-implantation. A second operation to de novo implant or complete an epicardial pacing system was performed in 49.4% (SR) and 39.3% (EL) of cases. Here, transvenous leads were added in 100% of cases, and in the EL group, 90.9% of epicardial leads implanted at extraction could be re-used.
The necessary second implant procedure was performed in the SR group at a median of 26 days after extraction, significantly earlier than in the EL group (62 days). Most commonly, pacemaker and CRT-D systems were then implanted. Interestingly, 50.6% of SR patients did not receive a new device since there was no further indication for pacemaker/ICD device.
Surgical wounds could be primarily closed in 94.2% of all groups. Vacuum-assisted wound closure (VAC therapy) with the aim of secondary wound closure was used only in individual cases with the highest percentage in the SR group (7.9%). Overall, there was only one case of a perioperative complication where myocardial rupture with hemorrhage occurred during implantation of an epicardial LV electrode. However, the complication was successfully treated and had no further long-term consequences (Tab. 2).