[HSF] Who Should Remove Chronic Pacemaker Leads?

[Ani Anyanwu]

Hal
 
In defence of Michael's institution, in most healthcare facilities the skills required for lead extraction lie with the cardiologists and not with the surgeons. Most surgical departments (at least worldwide and likely too in USA) do not have cardiac surgeons capable of performing laser lead extractions. I also suspect that there are few (if any) residency programs that include training in these advanced transvenous techniques, so asking Michael or us new surgeons to embrace them is somewhat unrealistic as we lack the skills to do so. Fellows lack time to gather the skills they do need to practice *surgery* so don't really get to acquiring other novelty techniques. I would actually like to know if there is any member on this list who actually undertakes these laser extractions. That we deal with the problems does not mean we have to be the ones doing the procedures (else we should do all the coronary angiograms, angioplasties, transvenous lines, dialysis catheters, cardiac biopsies, pericardial drainages, chest aspirations and all the other procedures that are occasionally complicated by injury to the heart or great vessels).
 
Of course if I were having a lead extraction, I would prefer it done by a surgeon in a cardiac OR rather than an electrophysiologist but I suspect surgeons so skilled are not that easy to come by. I still suspect though that the incidence of problems must be higher in Michael's group - to have put several patients on fem-fem bypass in a cathlab in a very short period Michael has been in his present institution is indeed unique. I have been called to provide surgical standby several times when the cardiologists are performing high-risk lead extractions and so far have never needed to do a thoracotomy. Putting these patients on bypass suggests there is a problem somewhere: either the way the patient had been managed (i.e. delay in surgical referral), a logistical problem in the institution prevent immediate institution of the definitive therapy (resuscitative thoracotomy), or an overkill by the surgeons.
 
Ani
 



> From: Hgrmd at aol.com> Date: Sun, 21 Oct 2007 17:16:14 -0400> Subject: Re: [HSF] Who Should Remove Chronic Pacemaker Leads?> To: OpenHeart-L at lists.hsforum.com> CC: > > Michael,> I understand that you have to go with the flow. Just understand that the > system you have could be made significantly safer if the surgeons were > actively involved. Those procedures don't often have problems, but when they do, > look out! It's a shame that what's best for the patient often takes a > backseat for profit.> > Hal> > > > ************************************** See what's new at http://www.aol.com> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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