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Dmitry Podolyak

Petrovsky National Research Center of Surgery, Russian Federation

Title: Modern approaches to transvenous lead extraction

Abstract

Aim: To show the effectiveness and safety of modern transvenous lead extraction (TLE) techniques used in cardiac surgery. Material and 

Methods: The study included 102 patients (men — 66, women — 36; mean age 58,3±1,7 years). Fifteen (14,7%) patients had infectious indications for TLE, 87 (85,3%) patients — non-infectious. Among the infectious indications (14,7%) were: isolated pocket infection of implantable electronic device (IED) — 13 (12,9%); pocket infection with bacteremia — 1 (0,9%); infectious endocarditis without pocket infection — 1 (0,9%). Of the non-infectious indications, 87 patients (85,3%) had: venous occlusion — 4 (3,9%); chronic pain at IED area — 10 (9,8%); device upgrade — 16 (15,7%); non-functioning (dysfunction, fracture) leads — 57 (55,9%).

Results: Using simple traction, 75 (50,4%) leads were removed. TLE technique was used in 56 (37,5%) extractions. Of these, telescoping/rotational mechanical dilators were used in 23 (15,4%) and 33 (22,1%) lead extractions, respectively. In 15 (14,7%) patients with infectious indications, 33 (22,1% of total) leads were removed. In 87 (85,3%) patients with noninfectious indications, 98 (65,8% of total) leads were removed. It was not possible to completely remove 18 (12% of total) leads. 

Conclusion: Currently, modern TLE techniques have shown their high efficiency and safety. It is confirmed by large international studies such as ELECTRA, LEXICon, PLEXES, where success rate reaches 97,7% and mortality does not exceed 0,5%. The successful application of modern techniques enlarged the list of indications and has been widely used in routine cardiac surgery.

Biography

Dmitry Podolyak highly professional and talented cardiologist with over 20 years' experience in diagnosing, intervening, and treating a wide range of heart and cardiovascular disorders as well as operating and handling various cardiac testing equipment and devices. Successful implantation and programming of over 1500 units of all types of cardiac devices (IPG, ICD, CRTD) from top companies such as Medtronic, Abbott, Boston scientific, and Biotronik. Successfully completed over 200 completed transvenous lead extractions. Possess excellent communication and interpersonal skills, organizational, and team-working skills, analytical and decision-making skills with the ability to remain updated with the latest medical developments. Demonstrated ability to provide exceptional care to patients and conduct extensive research and training in the field of cardiology. Defended his PhD dissertation in the field of cardiothoracic surgery with a thesis on "Diagnosis and surgical tactics in pseudo tumor diseases of the heart”. He holds a rank of assistant professor / senior lecturer at the department of cardiothoracic surgery at the national medical research center of surgery in Russia. He completed multiple training programs in France, Hungary, and Austria on cardiac device implantation and programming, as well as with Medtronic manufacturing training in Puerto Rico, USA to enhance knowledge of the device's specifications and programming conducted numerous internal and external training sessions on device implantation and programming.