Predictors and outcomes of TLE via femoral vein bailout - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Yuval Shafir ^1,2 Eyas Massalha ^1,2 Anat Milman ^1,2 Michael Glikson ^2,3 David Luria ^4,5 Avi Sabbag ^1,2 Roy Beinart ^1,2 Eyal Nof ^1,2 Eran Leshem ^1,2

¹Leviev Heart Institute, The Chaim Sheba Medical Center, Israel
²Sackler School of Medicine, Tel Aviv University, Israel
³The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Israel
⁴Heart Institute, Hadassah Medical Center, Israel
⁵Jerusalem Medical School, Hebrew University, Israel

BACKGROUND: Transvenous Lead Extraction (TLE) is usually performed via a superior approach. Predictors and outcomes of TLE via femoral vein bailout are ill defined.

METHODS: A single tertiary center cohort of 426 consecutive patients who underwent TLE between May 2010 and February 2020 were analyzed. Venography was routinely performed before system upgrade to identify occluded veins. Patients were divided into 2 groups on the basis of the need for femoral bailout extraction. Predictors for TLE requiring femoral bailout and outcomes were analysed.

RESULTS: A total of 928 leads were extracted and femoral bailout approach was needed in 49 patients (11.5%). A higher proportion of RV leads required femoral bailout approach [51/499 (10.2%)]. Femoral bailout was more common among younger patients, longer lead dwell time, more pocket entries, higher number of extracted leads, presence of abandoned leads [14/49 (28.6%)], and among patients with occluded veins [10/22(45.5%)]. The presence of abandoned leads, vascular occlusion and age remained a significant predictor for femoral bailout in multivariate analysis. Femoral bailout TLE resulted in a relatively higher rate of major complications [5/49 (10.2%) vs 9/377 (2.4%); p=0.02) but had no related intra-procedural mortality (0/3) and no additional 30 day mortality [2/49 (4.1%) vs 33/377 (8.8%); p=0.4].

CONCLUSION: TLE of abandoned leads, occluded veins and younger age were found to be predictors of femoral bailout requirement. Despite higher rates of major complications in femoral TLE bailout this did not result in increased mortality. Venography before TLE should be considered for procedure planning.