TY - JOUR
T1 - Safety of transvenous lead extraction according to centre volume
T2 - A systematic review andmeta-analysis
AU - Di Monaco, Antonio
AU - Pelargonio, Gemma
AU - Narducci, Maria Lucia
AU - Manzoli, Lamberto
AU - Boccia, Stefania
AU - Flacco, Maria Elena
AU - Capasso, Lorenzo
AU - Barone, Lucy
AU - Perna, Francesco
AU - Bencardino, Gianluigi
AU - Rio, Teresa
AU - Leo, Milena
AU - Di Biase, Luigi
AU - Santangeli, Pasquale
AU - Natale, Andrea
AU - Rebuzzi, Antonio Giuseppe
AU - Crea, Filippo
N1 - Publisher Copyright:
© The Author 2014.
PY - 2014/10
Y1 - 2014/10
N2 - Background: Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. Aim: Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. Methods: Of the 280 papers initially retrieved until February 2013, 66 observational studiesmet inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. Results: When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. Conclusions: In our meta-analysis of observational studies, patientswhohave been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction. Published on behalf of the European Society of Cardiology. All rights reserved.
AB - Background: Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. Aim: Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. Methods: Of the 280 papers initially retrieved until February 2013, 66 observational studiesmet inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. Results: When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. Conclusions: In our meta-analysis of observational studies, patientswhohave been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction. Published on behalf of the European Society of Cardiology. All rights reserved.
KW - Cardiac device infection
KW - Cardiac device malfunction
KW - Cardiac endocarditis
KW - Centre volume
KW - Transvenous lead extraction
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U2 - 10.1093/europace/euu137
DO - 10.1093/europace/euu137
M3 - Review article
C2 - 24965015
AN - SCOPUS:84911993568
SN - 1099-5129
VL - 16
SP - 1496
EP - 1507
JO - Europace
JF - Europace
IS - 10
ER -