LEAD EXTRACTION IN YOUNG-PATIENTS WITH AND WITHOUT CONGENITAL HEART-DISEASE USING THE SUBCLAVIAN APPROACH

Pacemaker lead removal using interlocking stylets and dilator sheaths has greatly reduced the need for major surgical intervention when lead extraction is required. Previous reports have shown the utility of th is method in older patients, most of whom have anatomically normal hea rts. The purpose of this study is to report the results of this techni que in young patients with and without congenital heart disease. There were 13 patients (M:F = 7:6) aged 9-26 years (median 13). Congenital heart disease was present in 8 of 13 patients. A total of 17 leads req uired removal; they had been implanted for 54 +/- 24 months (range 19- 94). Leads were removed from the left subclavian vein (13) or right su bclavian vein (4) only. Seventeen of 18 leads were completely removed and one partially retained in the left subclavian vein. New leads were implanted from the same vein in 11 of 13 patients. Interlocking style ts and metal or flexible dilator sheaths were used in all cases except two. There was one surgical complication: a late wound dehiscence, wh ich was easily managed. No patient required a transfusion, and there w as no structural damage noted in any patient on the postoperative echo cardiogram. We conclude that lead removal using interlocking stylets a nd dilator sheaths from the subclavian approach is an effective techni que that can be used in young patients, including those with congenita l heart disease.