Procedural Characteristics and Outcomes of Transvenous Lead Extraction in Patients With Prior Sternotomy

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BACKGROUND: A history of sternotomy has been debated as either a potential protective factor or a possible risk for worse outcomes in patients undergoing transvenous lead extraction (TLE). The safety and efficacy of TLE in this population remain underexplored. OBJECTIVES: This study sought to evaluate the impact of prior sternotomy on procedural outcomes in patients undergoing TLE. METHODS: Using a prospectively maintained registry, we included all patients undergoing TLE at our center between 1996 and 2022. Patients were categorized into 2 groups based on whether they had a prior sternotomy (PS). Baseline characteristics, procedural outcomes, and safety profiles were compared. Logistic regression was performed to identify independent predictors of major complications. RESULTS: Among 4,846 patients undergoing TLE, 1,344 (27.7%) had a prior sternotomy. These patients had a higher prevalence of comorbidities and an infectious indication for extraction. PS patients experienced significantly lower rates of major complications (1.4% vs 3.0%, P = 0.001), (1.2% vs 2.2%, P = 0.03), and emergent rescue cardiac surgeries (0.7% vs 1.6%, P = 0.011), with higher procedural success rates. On multivariable analysis, PS was independently associated with reduced odds of major complications (OR = 0.52; 95% CI: 0.30-0.89; P = 0.016) and major cardiovascular injury (OR = 0.54; 95% CI: 0.30-0.98; P = 0.043). These findings persisted in a propensity score-matched cohort of 1,256 pairs, confirming significantly lower complication rates in the PS group. CONCLUSIONS: Despite exhibiting higher comorbidities, PS patients had fewer major complications during TLE, suggesting a protective effect. Still, the challenges of repeat sternotomy highlight the need for recognizing these patients as high-risk should complications occur.

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