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Making lead extraction safer

      In this issue of HeartRhythm, Azarrafiy et al
      • Azarrafiy R.
      • Tsang D.
      • Boyle T.
      • Wilkoff B.
      • Carrillo R.G.
      Compliant endovascular balloon reduces the lethality of superior vena cava tears.
      report the findings of the initial use of a rescue device that is intended to tamponade a rent in the superior vena cava (SVC) that can occur during the extraction of chronically implanted pacemaker and defibrillator leads (Bridge, Spectranetics, Colorado Springs, CO). They mined data from the Manufacturer and User Facility Device Experience (MAUDE) database, a Food and Drug Administration registry of adverse events that are related to the use of medical devices. There were 9 uses of the balloon in confirmed SVC tears and 26 tears in which the rescue balloon was not used. All the patients in whom the balloon was used survived to discharge, whereas only 50% of those without balloon usage survived. Likewise, in 4 of those 9 cases, the SVC was repaired without the need for cardiopulmonary bypass, thereby making the procedure faster. While this report does not involve rigorously collected data, it reveals initial data that are quite compelling.
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      References

        • Azarrafiy R.
        • Tsang D.
        • Boyle T.
        • Wilkoff B.
        • Carrillo R.G.
        Compliant endovascular balloon reduces the lethality of superior vena cava tears.
        Heart Rhythm. 2017; 14: 1400-1404
        • Brunner M.P.
        • Cronin E.M.
        • Wazni O.
        • Baranowski B.
        • Saliba W.I.
        • Sabik J.F.
        • Lindsay B.D.
        • Wilkoff B.L.
        • Tarakji K.G.
        Outcomes of patients requiring emergent surgical or endovascular intervention for catastrophic complications during transvenous lead extraction.
        Heart Rhythm. 2014; 11: 419-425
        • Baker M.S.
        • Mounsey J.P.
        Balloon tamponade of the superior vena cava and the management of catastrophic complications of cardiac lead extraction.
        Heart Rhythm. 2017; 14: 761-762

      Linked Article

      • Compliant endovascular balloon reduces the lethality of superior vena cava tears during transvenous lead extractions
        Heart RhythmVol. 14Issue 9
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          Superior vena cava (SVC) lacerations have been identified as the most lethal complication encountered during cardiac implantable electronic device lead extraction. The case fatality rate of these events approximates 50% due to rapid exsanguination. A novel, compliant balloon specifically designed for use in the SVC may provide hemostasis in the event of endovascular perforation. By temporarily occluding the compromised vessel, the endovascular balloon should delay hemodynamic collapse, provide a more controlled surgical field for repair, and thereby reduce the mortality of SVC tears complicating transvenous lead extraction.
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