Chapter 7 110 2. Methods 2.1 Study population Using our prospective registry, all TLE procedures in the Erasmus MC (Rotterdam, the Netherlands) between January 2012 till Dec 2019 were evaluated. In the case of CIED related infection, there was a strong recommendation for early complete device and lead removal. In other cases, the decision to perform a TLE was made on a case-by-case basis after careful discussion with the patient integrating lead (e.g. recall lead, dwell time), procedural (e.g. risk of lead abandonment versus lead extraction) and patient characteristics (e.g. age, comorbidities, pacemaker [PM] dependency, patient preference). The institutional review board of the Erasmus MC approved this study. 2.2 Patient preparation All TLE procedures were performed in a cardiac catheterization laboratory or hybrid operating room by an experienced lead extraction team, consisting of at least 2 cardiologists, with immediate availability of cardiothoracic surgical backup. Most procedures took place under general anesthesia, unless the operator decided otherwise based on the anticipated procedural complexity considering the lead dwell time, lead characteristics (e.g. dual-coil ICD lead) and patient characteristics. Anticoagulation was interrupted to minimize the risk of bleeding. A preprocedural venography was performed to identify regions of severe venous stenosis or occlusion and adhesion sites. In patients under general anesthesia, a preprocedural transesophageal echocardiogram was performed to gain information on lead adhesions, vegetations and pre-existing pericardial effusion. The transesophageal echocardiography probe was left in situ to monitor the presence of pericardial effusion during the procedure. Sterile drapings were applied considering the possibility for access for contralateral implantation, emergent pericardiocentesis, thoracentesis, thoracotomy, sternotomy or cardiopulmonary bypass. All patients received invasive hemodynamic monitoring with a radial arterial line. Four units of packed red blood cells were readily available. A “time-out” procedure was performed to prepare the team for the approach of TLE, need for reimplant at the time of extraction, plans for retaining vascular access in case of reimplant and occluded
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