Document Detail


Incidence, risk factors, and outcome of traumatic tricuspid regurgitation after percutaneous ventricular lead removal.
MedLine Citation:
PMID:  19497444     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to evaluate the incidence, risk factors, and outcome of traumatic tricuspid regurgitation (TTR) induced by percutaneous removal of chronically implanted transvenous leads. BACKGROUND: Although lead removal using modern tools has been shown to be highly effective and safe, TTR has not been systematically evaluated. METHODS: All patients undergoing ventricular lead removal at our center were studied. Lead removal was performed by simple traction, laser sheath, and/or lasso technique. Presence of a new TTR after removal was assessed by transthoracic echocardiography. Pre-defined clinical and technical parameters were studied for their association with TTR. Patients were followed up by outpatient visits. RESULTS: We removed 237 ventricular leads in 208 patients. Median time from lead implantation was 46.4 months (range 0.7 to 260.5 months). A TTR occurred in 19 patients (9.1%), severe in 14. Three independent risk factors of TTR were found: use of laser sheath (p = 0.004), use of both laser sheath and lasso (p = 0.02), and female sex (p = 0.02). After a follow-up of 4,130 person-months (median 17.9 months), 5 TTR patients were medically treated for new right-sided heart failure symptoms, 2 had undergone surgical repair of the tricuspid valve, and 6 had died (2 from heart failure and 4 from noncardiac causes). Right-sided heart failure occurred only in patients with severe TTR. CONCLUSIONS: This study found that TTR is not uncommon after percutaneous lead removal. It is strongly associated with the use of additional tools beyond simple traction and also with female sex. In the long term, right-sided heart failure is frequent in patients with severe TTR.
Authors:
Frédéric Franceschi; Franck Thuny; Roch Giorgi; Islem Sanaa; Eric Peyrouse; Xavier Assouan; Sébastien Prévôt; Emilie Bastard; Gilbert Habib; Jean-Claude Deharo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  53     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-05     Completed Date:  2009-06-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2168-74     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Department, University Hospital La Timone, Marseilles, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Confidence Intervals
Defibrillators, Implantable / adverse effects*
Device Removal / adverse effects*,  instrumentation
Echocardiography
Echocardiography, Transesophageal
Electrodes, Implanted
Female
Heart Ventricles
Humans
Incidence
Male
Multivariate Analysis
Odds Ratio
Prospective Studies
Risk Factors
Treatment Outcome
Tricuspid Valve Insufficiency / epidemiology,  etiology*,  ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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