Stefania Blasi1, Maurizio Levantino1, Luca Paperini2, Maria Grazia Bongiorni2 and Uberto Bortolotti1*
1Section of Cardiac Surgery, Italy
2Cardiology, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
Received: 21 December, 2016; Accepted: 08 February, 2017; Published: 09 February, 2017
U Bortolotti, Section of Cardiac Surgery, University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy, Tel: 39-50-995250; Fax: 39-50-541647; E-mail:
Blasi S, Levantino M, Paperini L, Bongiorni MG, Bortolotti U (2017) Extraction of an Infected Active Fixation Coronary Sinus Lead with the Aid of a Tissue Stabilizer. J Cardiovasc Med Cardiol 4(1): DOI: 10.17352/2455-2976.000036
© 2017 Blasi S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Cardiomyopaties dilated; Endocarditis; Cardiopulmonary bypass
We present a 49-year-old man who required extraction of a cardiac resynchronization device due to lead infection. While 2 leads were successfully retrieved by a transvenous approach the third one with active fixation and entrapped into a coronary sinus side-branch, required surgical intervention. During the operation, performed on cardiopulmonary bypass on a beating heart, lead extraction was greatly facilitated by employment of a tissue stabilizer routinely used for off-pump coronary surgery.
Coronary sinus (CS) lead implantation for cardiac resynchronization therapy (CRT) is associated with a significant rate of lead dislodgment [1,2]. The use of a lead with an active-fixation mechanism (e.g. deployable polyurethane lobes on the lead body) inserted into a CS branch allows reduction of lead dislodgment rate and decreases the risk of loss of pacing and phrenic nerve stimulation . Because of fibrotic adhesions between polyurethane lobes and coronary sinus endothelium removal of implanted active-fixation leads, at variance with those with passive-fixation, may be technically challenging and sometimes it cannot be performed transvenously thus requiring surgical intervention .
We describe the case of a patient with an infected CRT device who required surgical removal of an active-fixation lead, entrapped into a CS collateral vein on cardiopulmonary bypass and beating heart; lead extraction was greatly facilitated by the use of a tissue stabilizer.
A 49-year-old male was admitted to our hospital in October 2015 to perform a lead extraction procedure for a CRT device-related infection. In 2008, after evidence of dilated cardiomyopathy he received a CRT defibrillator employing three different leads among which an Attain StarFix™ Model 4195 (Medtronic Inc., Minneapolis, MN, USA) was implanted; this is an unipolar lead with an extendable active fixation mechanism through small polyurethane lobes which, after deployment, are conceived to firmly fixate the lead into a CS venous collateral. The patient had a good clinical response to the CRT therapy but after 5 years he had a reintervention to fix a traumatic fracture of the StarFix™ lead; after 14 months signs of local pocket infection appeared without signs or symptoms of systemic infection (white cells 7660/uL, ESR 12 mm/hr, procalcytonin 0,10 ng/ml). Hospital admission was performed to extract the entire CRT system. The generator was removed and transvenous extraction of the leads was attempted. Two of the three leads were completely removed with conventional mechanical dilatation , however, multiple attempts to remove the StarFix™ lead were unsuccessful since it appeared to be entrapped into a CS side-branch most likely occluded by thrombosis (Figure 1). Therefore surgical extraction of the lead was considered indicated.
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