Safety of Extraction | RIO 2024

Chair Richard Schilling (London, UK) led a discussion on the safety of lead extraction, featuring presentations from Aldo Rinaldi (London, UK) and Brigitte Osswald (Duisburg, DE), with panel insights from Robert Schaller (Philadelphia, US). Prof Rinaldi highlighted the growing need for transvenous lead extraction (TLE) due to rising device-related infections, emphasising early intervention to reduce mortality. He reviewed real-world data showing underutilisation of TLE despite improved survival rates, stressing the importance of high-volume centres and pre-procedural risk stratification using tools like the EROS score. He outlined the role of mechanical, laser and femoral extraction tools, with data suggesting similar success rates between laser and mechanical approaches. Prof Osswald expanded on safety measures, particularly preoperative imaging, to prevent complications during extraction. She demonstrated cases where leads were misrouted, emphasising the need for detailed anatomical assessment before extraction. Both Prof Rinaldi and Prof Osswald discussed the importance of having a surgical team on standby and the use of a bridge balloon for managing superior vena cava (SVC) injuries, citing its ability to improve survival rates by controlling haemorrhage. Dr Schaller reinforced the importance of institutional readiness, particularly for urgent cases, advocating for greater procedural flexibility to ensure timely extractions. The session concluded with agreement on the necessity of MDT discussions, experienced centres and standardised safety protocols to improve patient outcomes.