{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T22:55:35Z","timestamp":1784156135737,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T00:00:00Z","timestamp":1671580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Lead dwell time &gt;10 years is a recognized predictor for transvenous lead extraction (TLE) failure and complications. Data on the efficacy and safety of TLE using the bidirectional rotational mechanical sheaths in patients with very old leads are lacking. In this multicenter study, we reported the outcomes of transvenous rotational mechanical lead extraction in patients with leads implanted for \u226510 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 441 leads (median: 159 months [135\u2013197]; range: 120\u2013487) in 189 consecutive patients were removed with the Evolution RL sheaths (Cook Medical, Bloomingtom, IN, USA) and mechanical ancillary tools supporting the procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The main indication for TLE was infection in 74% of cases. Complete procedural success rate, clinical success rate, per lead were 94.8% and 98.2%, respectively. Failure of lead extraction was seen in 1.8% of leads. The additional use of a snare via the femoral approach was required in 9% of patients. Lead dwell time was the only predictor of incomplete led removal (odds ratio: 1.009; 95% confidence interval [CI]: 1.003\u20131.014; <jats:italic>p<\/jats:italic>\u2009=\u2009.002). Four\u00a0major complication (2%) were encountered. During a mean time follow\u2010up of 31\u2009\u00b1\u200927 months, 21 patients (11%) died. No procedure\u2010related mortality occurred. Predictors of mortality included severe left ventricular systolic dysfunction (hazard ratio [HR]: 8.06; 95% CI: 2.99\u201321.73; <jats:italic>p<\/jats:italic>\u2009=\u2009.001), TLE for infection (HR: 8.0; 95% CI: 1.04\u201362.5; <jats:italic>p<\/jats:italic>\u2009=\u2009.045), diabetes (HR: 3.7; 95% CI: 1.48\u20139.5; <jats:italic>p<\/jats:italic>\u2009=\u2009.005), and previous systemic infection (HR: 3.1; 95% CI: 1.17\u20138.24; <jats:italic>p<\/jats:italic>\u2009=\u2009.022). Incomplete lead removal or failure lead extraction did not impact on survival during follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings demonstrated that the use of bidirectional rotational TLE mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in patients with very old leads at experienced specialized centers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15767","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T17:44:45Z","timestamp":1670435085000},"page":"728-737","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Outcomes of transvenous lead extraction of very old leads using bidirectional rotational mechanical sheaths: Results of a multicentre study"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8574-9421","authenticated-orcid":false,"given":"Federico","family":"Migliore","sequence":"first","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimondo","family":"Pittorru","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5572-2620","authenticated-orcid":false,"given":"Pietro Bernardo","family":"Dall'Aglio","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"De Lazzari","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Rovaris","sequence":"additional","affiliation":[{"name":"Department of Cardiology San Gerardo Hospital Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Piazzi","sequence":"additional","affiliation":[{"name":"Department of Cardiology San Gerardo Hospital Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Dentico","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Ospedale Policlinico Consorziale Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Ferrieri","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Ospedale Policlinico Consorziale Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"D'Angelo","sequence":"additional","affiliation":[{"name":"Departement of Cardiac Electrophysiology and Arrhythmology San Raffaele Hospital Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Marzi","sequence":"additional","affiliation":[{"name":"Departement of Cardiac Electrophysiology and Arrhythmology San Raffaele Hospital Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basma El","family":"Sawaf","sequence":"additional","affiliation":[{"name":"Departement of Cardiac Electrophysiology and Arrhythmology San Raffaele Hospital Milano 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