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).