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| 2. |
- Kennergren, Charles, 1948, et al.
(författare)
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Laser-assisted lead extraction: the European experience.
- 2007
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1099-5129. ; 9:8, s. 651-6
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction in Europe. The final European multi-centre study experience is presented. METHOD AND RESULTS: The Excimer is a cool cutting laser (50 degrees C) with a wavelength of 308 nm. The energy is emitted from the tip of a flexible sheath and is absorbed by proteins and lipids, 64% of the energy is absorbed at a tissue depth of 0.06 mm. The sheath is positioned over the lead, and the fibrosis surrounding the lead is vaporized while advancing the sheath without damaging other leads. From August 1996 to March 2001, 383 leads (170 atrial, 213 ventricular) in 292 patients (mean age 61.6 years, range 13-96) were extracted at 14 European centres. Mean implantation time was 74 months (3-358). Most frequent indications were pocket infection (26%), non-functional leads (21%), patient morbidity (21%), septicaemia or endocarditis (14%), erosion (5%), and lead interference (8%). Median extraction time was 15 min (1-300). Complete extraction was achieved in 90.9% of the leads and partial extraction in 3.4%. Extraction failed in 5.7% of the leads. Major complications = perforations caused 10/22 (3.4/5.7%) of the failures. Most partially extracted patients were considered clinically successful, as only minor lead parts without clinical significance were left. Femoral non-laser technique was used to remove 8/12 of the non-complication failures. The total complication rate, including five minor complications (1.7%), was 5.1%. No in-hospital mortality occurred. CONCLUSION: Pacing and implantable cardioverter-defibrillator leads can safely, effectively, and predictably be extracted. Open-heart extractions can be limited to special cases. The results indicate that the traditional policy of abandoning redundant leads, instead of removing them, may be obsolete in many patients.
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| 3. |
- Arora, Y., et al.
(författare)
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Location of Superior Vena Cava Tears in Transvenous Lead Extraction
- 2022
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975. ; 113:4, s. 1165-1171
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Superior vena cava (SVC) tears are rare but potentially lethal complications associated with transvenous lead extraction. When lacerations occur, surgeons need to be prepared for an emergent response. Nonetheless, little is known about the precise whereabouts of these lesions. Understanding the location and injury patterns enables a more anticipated and targeted surgical response.& nbsp;METHODS We collected data via physician interviews after an SVC laceration occurred. These physicians were identified through the US Food and Drug Administration's Manufacturer and User Facility Device Experience database and independent physician reports of adverse events. We identified 116 reports of SVC tears between July 1, 2016, and July 31, 2018. For an SVC tear to be included in our registry, a cardiothoracic surgeon had to be physically present to confirm the injury via emergent sternotomy. In each case, the surgeon recorded the SVC injury's exact location after a repair was attempted.& nbsp;RESULTS During the study period, 116 SVC tears were confirmed by sternotomy. Tears occurred in any combination of the following locations: SVC-innominate vein, body of the SVC, and SVC-right atrial junction. The majority of tears (n = 72; 62%) were located in the isolated body of the SVC, followed by the SVC-right atrial junction (n = 23;19.8%) and the SVC-innominate junction (n = 17;14.6%). Combined tears were rare, accounting for only 3.6% (n = 4) of the adverse events recorded.& nbsp;CONCLUSIONS Most SVC tears occurred in the isolated body of the SVC. The second most common location was the SVC-right atrial junction. The SVC-innominate junction was the third most common location for these injuries. Combined tears were uncommon. & nbsp;(C)& nbsp;2022 by The Society of Thoracic Surgeons
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| 4. |
- Boehmer, John P, et al.
(författare)
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Adjudication of mortality events in a heart failure-arrhythmia trial by a multiparameter descriptive method: comparison with methods used in heart failure trials and methods used in arrhythmia trials.
- 2008
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1383-875X. ; 23:2, s. 101-10
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Mortality events in studies of cardiovascular disease are currently adjudicated using different methodologies depending on the investigators' preferences. Traditionally, deaths have been categorized by a single term, such as sudden, ischemic, or pump failure, a method that can be referred to as "categorical". In contrast, deaths may be categorized using several specific pieces of information about the event, a method that can be referred to as "multiparameter descriptive." Herein, we describe an adaptation of this descriptive method in a trial of patients with heart failure and arrhythmias. METHODS AND RESULTS: Case examples were selected from two clinical trials of an investigational implantable cardioverter-defibrillator (ICD)-biventricular pacing system in patients with symptomatic heart failure and a class I indication for ICD implantation, and the complete results for one of the trials are given. Deaths were classified according to the new descriptive method, and also according to published categorical methods for heart failure and arrhythmia trials. The descriptive method preserved traditional arrhythmia and heart failure trial single category classifications of death. Furthermore, there was agreement between the arrhythmia and heart failure category classifications in 126 of the 148 of the mortality events adjudicated (85%). CONCLUSION: A descriptive method for the classification of death retains more data and allows for comparison among trials using different classification schemes. This may allow greater mechanistic insight into study populations that have diverse and frequently multiple etiologies of death.
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| 5. |
- Bratel, John, 1953, et al.
(författare)
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Treatment of oral infections prior to heart valve surgery does not improve long-term survival
- 2011
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Ingår i: Swedish Dental Journal. - 0039-6745. ; 35:2, s. 49-55
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to evaluate the importance of preoperative elimination of oral infections and oral health for survival after heart valve surgery In a group of patients (n=149; treatment group, GP group), oral health was examined and dental treatment was performed 3-6 months prior to heart valve surgery. In a second group (n=103; control group, SP group), oral health was examined postoperatively, but patients did not receive dental treatment prior to surgery. Sixteen years after heart valve surgery was performed, morbidity endpoint data were obtained. Differences in survival between the two groups and the influence of differences in oral health were analyzed. Fewer patients survived in the study group (37%) compared with the control group (45%). Mean survival was 122.9 months in the GP group compared with 143.3 months in the SP group, including time to death and those alive at the endpoint (p=0.018). A positive relationship was found between the number of teeth and survival, with RR = 0.98 (95% CI 0962-0.996 (p=0.016)).The deaths from heart valve disease were 18% in the GP group and 7% in the SP group (chi2=3.65, df=1, p=0.56). At the long-term follow-up,the results of the present study show,that it was not possible to demonstrate that dental treatment before heart valve surgery improved survival. Therefore, the need for extensive dental treatment prior to heart valve surgery may be reconsidered.
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| 6. |
- Gottfridsson, Christer, 1958, et al.
(författare)
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Acute evaluation of transthoracic impedance vectors using ICD leads.
- 2009
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Ingår i: Pacing and clinical electrophysiology : PACE. - : Wiley. - 1540-8159 .- 0147-8389. ; 32:6, s. 762-71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Minute ventilation (MV) has been proven to be very useful in rate responsive pacing. The aim of this study was to evaluate the feasibility of using implantable cardioverter-defibrillator (ICD) leads as part of the MV detection system. METHODS: At implant in 10 patients, the transthoracic impedance was measured from tripolar ICD, tetrapolar ICD, and atrial lead vectors during normal, deep, and shallow voluntary respiration. MV and respiration rate (RespR) were simultaneously measured through a facemask with a pneumotachometer (Korr), and the correlations with impedance-based measurements were calculated. Air sensitivity was the change in impedance per change in respiratory tidal volume, ohms (Omega)/liter (L), and the signal-to-noise ratio (SNR) was the ratio of the respiratory and cardiac contraction components. RESULTS: The air sensitivity and SNR in tripolar ICD vector were 2.70 +/- 2.73 ohm/L and 2.19 +/- 1.31, respectively, and were not different from tetrapolar. The difference in RespR between tripolar ICD and Korr was 0.2 +/- 1.91 breaths/minute. The regressed correlation coefficient between impedance MV and Korr MV was 0.86 +/- 0.07 in tripolar ICD. CONCLUSIONS: The air sensitivity and SNR in tripolar and tetrapolar ICD lead vectors did not differ significantly and were in the range of the values in pacemaker leads currently used as MV sensors. The good correlations between impedance-based and Korr-based RespR and MV measurements imply that ICD leads may be used in MV sensor systems.
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| 7. |
- Kennergren, Charles, 1948
(författare)
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A European perspective on lead extraction: part I.
- 2008
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Ingår i: Heart rhythm : the official journal of the Heart Rhythm Society. - : Elsevier BV. - 1547-5271. ; 5:1, s. 160-2
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Kennergren, Charles, 1948, et al.
(författare)
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A single-centre experience of over one thousand lead extractions.
- 2009
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 11:5, s. 612-7
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of the study was to present a single-centre experience of pacemaker and implantable cardioverter defibrillator (ICD) lead extraction using different methods, mainly laser-assisted extraction. METHODS AND RESULTS: Data from 1032 leads and 647 procedures were gathered. A step-by-step approach using different techniques while performing an ongoing risk-benefit analysis was used. The most common indications were local infection, systemic infection, non-functional lead, elective lead replacement, and J-wire fracture. Mean implantation time for all leads was 69 months and for laser-extracted leads 91 months. Laser technique was used to extract 60% of the leads, 29% were manually extracted, 6% extracted with mechanical tools, 4% were surgically removed, and 0.6% extracted by a femoral approach. Failure rate was 0.7%, and major complication rate was 0.9%. No extraction-related mortality occurred. Median time for laser extraction was 2 min. Long implantation time was not a risk factor for failure or for complication. CONCLUSION: Pacing and ICD leads can safely, successfully, and effectively be extracted. Leads can often be extracted by a superior transvenous approach; however, open-chest and femoral extractions are still required. Laser-assisted lead extraction proved to be a useful technique to extract leads that could not be removed by manual traction. The results indicate that the paradigm of abandoning redundant leads, instead of removing them, may have to be reconsidered.
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| 9. |
- Kennergren, Charles, 1948
(författare)
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Cardiac implantable electronic device treatment: taking care of complications.
- 2009
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 11:11, s. 1419-20
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Tidskriftsartikel (refereegranskat)
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| 10. |
- Kennergren, Charles, 1948
(författare)
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Cellular monitoring in open heart surgery. Monitoring of markers for ischemia, free amino acids, glucose and lactate in the myocardial interstitial fluid before, during and after cardiac surgery using microdialysis technique
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Protection of the myocardium during open-heart surgery is a field of intense development. Numerous protocols have been proposed to minimize ischemia, since the beginning of open-heart surgery more than 40 years ago. Their evaluation is largely based on clinical outcome, since available methods lack the sensitivity required to determine the effects on myocardial oxygenation by small, but sometimes critical, methodological developments. We applied microdialysis to the myocardium with the aim to monitor the degree of ischemia from the concentrations of ASAT, troponin-T, free amino acids, glucose and lactate before, during and after cardioplegia. We also aimed at correlating postoperative events with the concentration of these markers. The myocardium of a mixed group of patients undergoing coronary artery by-pass grafting (CABG) and/or aortic valve surgery was monitored with a flexible microdialysis probe developed in our laboratory. The safety and function of the probe was first examined in an animal model for myocardial ischemia and then confirmed in man. Specific time courses were found in the interstitium for ASAT, troponin-T and several amino acids, during and after cardioplegia. Twenty and 300 times higher peak concentrations than in plasma were recorded in the interstitium for ASAT and troponin-T, respectively. The regulation of glucose and lactate was studied in the myocardial interstitium before, during and after cardioplegia in another group of patients undergoing CABG surgery. Concentrations of glucose and lactate were, to our knowledge, determined for the first time in the myocardial interstitium, with the use of internal calibration. Glucose was not critically reduced during cardioplegia, nor did lactate reach pathologically high concentrations. Even though transient elevations of marker levels coincided with postoperative clinical events in a number of patients, a larger population than was studied would be required for significant correlation. It is concluded that microdialysis sampling of the myocardial interstitial fluid is a safe procedure in clinical use. The approach has a potential for the evaluation of new technology for myocardial protection and for postoperative surveillance
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