# Safety Outcomes of Hybrid Open Chest Transvenous Lead Extraction: A Multicenter Experience

## TL;DR

This study examines the safety and outcomes of a combined surgical and endovascular procedure for removing heart leads, finding high success rates and identifying risk factors for complications.

## Contribution

The study provides novel outcome data on hybrid open chest transvenous lead extraction in a high-risk patient population.

## Key findings

- Clinical procedural success was 97.5% with an in-hospital mortality rate of 2.5%.
- Chronic lung disease independently predicts severe complications (OR 102.2).
- Atrial fibrillation is an independent predictor of any complication (OR 5.83).

## Abstract

Hybrid open chest transvenous lead extraction (TLE), combining surgical and endovascular techniques, may be utilized in patients requiring concomitant cardiac surgery or with high‐risk features for endovascular extraction. Outcome data in this population remains sparse.

To evaluate procedural outcomes and identify predictors of complications in patients undergoing elective hybrid open chest TLE.

A retrospective multicenter cohort study was conducted, including 40 patients between 2017 and 2025 across three UK tertiary centers. Patients undergoing emergency surgical conversion were excluded. Baseline, procedural, and outcome data were collected. Primary outcomes were in‐hospital mortality and complications, graded using a modified Delphi classification. Logistic regression was used to identify predictors of any or severe (Delphi grade ≥3) complications.

The mean age was 61.9 ± 17 years; 62.5% were male. Median lead dwell time was 10.5 years. The indication was infection in 65% of cases. Concomitant valve intervention was performed in 77.5% of cases. Clinical procedural success was 97.5%. In‐hospital mortality was 2.5%, with a rate of severe complications of 15%, and an overall complication rate of 37.5%. Multivariable analysis identified chronic lung disease as an independent predictor of severe complications (OR 102.2, p = 0.03). Atrial fibrillation was an independent predictor of any complication (OR 5.83, p = 0.04), driven primarily by post‐procedure rhythm intervention. Lead dwell time and EROS classification were not associated with adverse outcomes.

Hybrid open chest TLE demonstrates high procedural success and despite significant morbidity, has acceptable mortality rates. Chronic lung disease independently predicts complications and should guide patient selection and perioperative planning.