Keyser, Andreas and Schopka, Simon and Jungbauer, Carsten and Foltan, Maik and Schmid, Christof (2018) Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture. JOURNAL OF CARDIOTHORACIC SURGERY, 13: 102. ISSN 1749-8090,
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Background: In cases of lead failure after implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD) early lead replacement may be challenging. Puncture of the subclavian vein bears possible complications such as pneumothorax, hematothorax, and damage of leads to be left in place. To avoid venous puncture PM or ICD leads were replaced using a flexible polypropylene sheath (Byrd-sheath). Method: From January 2010 through December 2017, 55 patients underwent early lead exchange avoiding venous puncture. Early lead exchange for this study was defined as a reintervention within 14 days after the initial lead implantation. The connector of the malfunctioning lead was cut off, and stabilized by a stiff stylet. After having cut off the plastic knob of the stylet, the lead was passed through the polypropylene sheath and the latter advanced into the subclavian vein with gentle rotational movements to gain access to the subclavian vein. After lead removal the polypropylene sheath was replaced by a peel away sheath a new lead inserted. Results: Overall, 23 defibrillation leads and 34 pacing leads (16 right atrial leads, 17 right ventricular leads, and 1 left ventricular lead) were successfully explanted. Access to the subclavian vein was uneventful, and blood loss minimal. Radiation exposure and fluoroscopy time were also negligible. Conclusion: The Byrd-sheath technique proved to be safe and successful in providing vein access within 2 weeks after initial lead implantation using the previously implanted lead and thus avoiding puncture of the subclavian vein.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PACEMAKER; IMPLANTATION; EXTRACTION; Pacemaker; Implantable cardioverter defibrillator; Lead exchange; Polypropylene sheath; Venous puncture |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 05 Dec 2019 14:08 |
| Last Modified: | 05 Dec 2019 14:08 |
| URI: | https://pred.uni-regensburg.de/id/eprint/13711 |
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