Cardiac tamponade as an inherent but potentially nonfatal complication of transvenous lead extraction: Experience with 1126 procedures performed using mechanical tools.

INTRODUCTION: Cardiac tamponade (CT) is one of the most common and dangerous complications of transvenous lead extraction (TLE). So far, however, there has been little discussion about the problem. METHODS: We analyzed the occurrence of CT in a group of 1226 patients undergoing TLE at a single reference center between June, 2015 and February, 2021. Using standard mechanical devices as first-line tools, a total of 2092 leads had been extracted. RESULTS: CT occurred in 18 patients (1.47%): due to injury to the wall of the right atrium in 14 patients (1.14%) and other cardiac walls in four patients (0.33%). Younger patient age at first implantation, female gender, high left ventricular ejection fraction (LVEF), lower New York Heart Association class, low Charlson comorbidity index, longer implant duration, and the number of previous procedures related to cardiac implantable electronic devices (CIED) are important patient-related risk factors for CT. Significant procedure-related risk factors include the number of extracted leads, extraction of atrial leads and longer dwell time of extracted leads. Intraoperative transoesophageal echocardiography (TEE) provides a lot of information about pulling on various cardiac structures and is able to detect a very early phase of bleeding to the pericardial sac. As a result of implementing best practices guidance in performing extraction procedures and close collaboration with cardiac surgeons that allowed immediate rescue intervention in our series of 18 CT cases, there were no procedure-related deaths (mortality 0%). CONCLUSIONS: The need for rescue surgery due to CT has no influence on clinical and procedural success. Early diagnosed (TEE monitoring) and properly managed CT does not generate any additional risk in short- and long-term follow-up after TLE.

[Thermodilution vs transesophageal echocardiography for cardiac output measurement in patients with good left ventricle function]. / Porównanie rzutu minutowego serca mierzonego metoda termodylucji i echokardiografii przezprzelykowej u chorych z dobra czynnoscia skurczowa lewej komory.

BACKGROUND: Transesophageal echocardiography (TEE) has been regarded as a standard diagnostic method for assessment of cardiac output in aortic dissection, pulmonary embolism, atrial and ventricular septal defects, and acquired valvular defects. It is also a standard method of assessment of the adequacy of their surgical repair. It allows for on-line estimation of ejection fractions and stroke volumes, and calculation of cardiac output. In this prospective study, we compared the cardiac outputs estimated by aortic continuous-wave Doppler, and pulse wave Doppler via transgastric long-axis imaging plane TEE, with results obtained by thermodilution. METHODS: Cardiac output was determined in thirty adult patients, of both sexes, with good left ventricular function, scheduled for off pump coronary artery bypass grafting. Aortic valve area was plotted from the transverse short-axis view of the valve assuming a triangular shape for the valve orifice. RESULTS: Mean cardiac output measured by thermodilution [CO(S-G)] was 4.59 +/- 2.5 L min(-1), compared to 4.49 +/- 1.14 L min(-1) obtained from contour wave [CO(CW)] and 4.57 +/- 1.29 L min(-1) from continuous-wave [CO(PW)] analysis. The correlation coefficient (r) between CO(S-G) and CO(CW) was 0.939, (p < 0.001).The correlation coefficient (r) between CO(S-G) and CO(PW) was 0.912 (p < 0.001). CONCLUSIONS: Results of cardiac output measurements, obtained from all three methods, were comparable.