Prognostic value of renal failure in patients undergoing transvenous lead extraction: single centre experience and systematic review of the literature

ABSTRACT

Introduction

Cardiac implantable electronic device infections (CIEDI) are challenging complications, associated with high mortality rate. Transvenous lead extraction (TLE) is the only curative treatment for CIEDI. Albeit continuous improvement in tools and techniques dramatically decreased TLE associated complications, survival after TLE for CIEDI is still poor. Renal failure (RF) is frequently reported in candidates to TLE, but due to variability in its definition, the real prevalence is not well defined.

Objective

Considering the impact of RF on mortality among patients affected by cardiovascular diseases, we aimed our research at defining the role of RF as a predictor of post-TLE mortality.

Method and Results

We will provide the results of a systematic revision of literature on the impact of RF on mortality at different time points after TLE, according to the various definitions adopted for RF. Considering the high variability of literature in this field, we will provide the results of an explorative analysis comparing the different definitions of RF on clinical outcomes in a cohort of candidates to TLE for CIEDI in a high-volume referral center.

Conclusion

We discuss the possible reasons of the negative impact of RF after TLE, providing new perspectives for future research.

KEYWORDS:

• Cardiac implantable electronic device infection
• renal failure
• transvenous lead extraction
• mortality
• systematic review

Article highlights

• RF is a relevant predictor of mortality after TLE

• Haemodialysis is a predictor of short-term mortality (<30 days after TLE), while 1-year mortality progressively increases according from CrCl <60ml/min to CrCl <30 ml/min

• RF should be carefully considered in candidates to any CIED procedure, especially in the management after TLE

• Future studies are warranted to define the relationship between RF and CIEDI

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.