P967
Lead extraction in patients under 18 years old, single surgeon experience

Background: Implantation of pacemakers and defibrillators in patients younger than 18 years has been extended over time and this has resulted in a greater number of complications that forced the removal of their leads.

Purpose: The aim is to show the experience in the extraction of leads in patients under 18 years.

Methods: Given that pediatric institutions have few extractions, and therefore their experience is limited, operations were conducted in these institutions (15), by an expert surgeon in lead extraction in adults, seconded by pediatricians. This is a personal experience that began on 20/July/93 to 30/September/16. A total of 954 patients (P) from whom were extracted 1678 leads (L), were treated 38 P under 18 years, with an average of 12.55 years, 22 males (57.9%). L extracted were 50, 9 atrial, 31 ventricular and 10 defibrillator. The atrial L were all active fixation, with an implant duration of 42 months (m) between 12 m and 92 m. Among ventricular L, there were 21 L with passive fixation and 10 L with active fixation, with an implant duration of 58.66 m, between 10 m and 134 m. The defibrillator L were all active fixation except 1, with an implant duration of 39.5 m, between 10 m and 131 m. Indications for lead extraction: abandoned 2 L, pocket infection 15 L, pacemaker associated endocarditis 5 L, multiple leads 3 L, malfunction 24 L and incompatibility with MRI 1 L.

Results: There were 44 L with complete extraction (88%), partially 5 L (10%) (one of 36 m, two of 92 m, a 103 m and a 40 m) an atrial L and four ventricular L. There was a failing extraction on a defibrillator L (2%) of 131 m, requiring open surgery for removal. One procedure was combined with open surgery as well as the extraction required a tricuspid valve intervention. Fibrous tissue in young P is much stronger than in adults and in the elderly, that’s why the effectiveness is lower with respect to the total number of L extracted, which in this database is complete extractions 95.53%, partial withdrawals 3.63% and failures 0.83%. During the same surgery they were reimplanted 32 P. There were no major or minor complications.

Conclusion: Transvenous lead extraction of pacemaker and defibrillator leads in patients under 18 is possible and safe, though their effectiveness is lower than in adults and the elderly.