Prognostic Value of Preoperative Echocardiographic Findings in Patients Undergoing Transvenous Lead Extraction

Dorota Nowosielecka, Wojciech Jacheć, Anna Polewczyk, Łukasz Tułecki, Andrzej Kleinrok and Andrzej Kutarski
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Dorota Nowosielecka: Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Wojciech Jacheć: 2nd Department of Cardiology, Silesian Medical University, 40-055 Zabrze, Poland
Anna Polewczyk: Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
Łukasz Tułecki: Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Andrzej Kleinrok: Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Andrzej Kutarski: Department of Cardiology, Medical University, 20-059 Lublin, Poland

IJERPH, 2021, vol. 18, issue 4, 1-20

Abstract: (1) Background: In patients referred for transvenous lead extraction (TLE) transesophageal echocardiography (TEE) often reveals abnormalities related to chronically indwelling endocardial leads. The purpose of this study was to determine whether the results of pre-operative TEE might influence the long-term prognosis. (2) Methods: We analyzed data from 936 TEE examinations performed at a high volume center in patients referred for TLE from 2015 to 2019. The follow-up was 566.2 ± 224.5 days. (3) Results: Multivariate analysis of TEE parameters showed that vegetations (HR = 2.631 [1.738–3.983]; p < 0.001) and tricuspid valve (TV) dysfunction unrelated to the endocardial lead (HR = 1.481 [1.261–1.740]; p < 0.001) were associated with increased risk for long-term mortality. Presence of fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.285; p = 0.035), presence of penetration or perforation of the lead through the cardiac wall up to the epicardium (HR = 0.496; p = 0.035) and presence of excessive lead loops (HR = 0.528; p = 0.026) showed a better prognosis. After adjustment the statistical model with recognized poor prognosis factors only vegetations were confirmed as a risk factor (HR = 2.613; p = 0.039). A better prognosis was observed in patients with fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040). (4) Conclusions: Non-modifiable factors may have a negative influence on long-term survival after TLE. Various forms of connective tissue overgrowth and abnormal course of the leads modifiable by TLE can be a factor of better prognosis after TLE.

Keywords: transesophageal echocardiography; vegetations; tricuspid valve dysfunction; transvenous lead extraction; long-term survival (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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