Background. Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. Objectives. Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centers with low, medium and high volume of procedures. Methods. Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; 2 were defined “experience studies”. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium and high volume centers utilizing either the European Heart Rhythm Association (EHRA) and Lexicon classification criteria. Results. When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intra operative deaths. In contrast, both minor complications and mortality at 30 days decreased as center volume increased. Conclusions. In our meta-analysis of observational studies, patients that have been treated in higher volume centers have a lower probability of minor complications and death at 30 days regardless of infection rate, length of lead duration, type of device and type of extraction.
Safety of transvenous lead extraction according to volume center: a systematic review and meta-analysis
MANZOLI, Lamberto;FLACCO, MARIA ELENA;CAPASSO, LORENZO;
2014-01-01
Abstract
Background. Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. Objectives. Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centers with low, medium and high volume of procedures. Methods. Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; 2 were defined “experience studies”. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium and high volume centers utilizing either the European Heart Rhythm Association (EHRA) and Lexicon classification criteria. Results. When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intra operative deaths. In contrast, both minor complications and mortality at 30 days decreased as center volume increased. Conclusions. In our meta-analysis of observational studies, patients that have been treated in higher volume centers have a lower probability of minor complications and death at 30 days regardless of infection rate, length of lead duration, type of device and type of extraction.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
