Success and complication rate of Tightrail mechanical percutaneous lead extraction: A multicentre French study

Background Our objective was to assess Philips TightRail rotating dilator sheath efficacy and safety for extraction of endocardial leads. No large-scale multicenter data is available on this mechanical lead extraction device, now commonly used in France. Methods and results We conducted a retrospective, multicentre (from 4 French university hospitals) study. These centres that only perform mechanical lead extraction using this device were selected on the basis of the annual volume of procedures (> 10 leads/year). All patients from January 2015 to January 2020 who underwent at least one extraction of an endocardial lead with using TightRail were included. All of the extracted leads were > 12 months old and indications for extraction were based on ESC guidelines. Overall, 395 leads were extracted using TightRail in 203 patients (mean age 70 years, 75% male sex). Indications for lead removal included cardiac device infection in 172 (85%) cases, lead malfunction in the 25 (12%) cases, vein thrombosis in 3 (1.5%) cases and 3 for other indications (1.5%). The extracted devices were pacemaker in 134 (66%) cases, implantable cardioverter-defibrillator (ICD) in 69 (44%) cases. The mean time from implantation was 124 months. Complete procedural success with TightRail system alone was achieved in 180 (89.1%) patients (352 leads) and overall clinical success was 93% (367 leads). Fifteen right-sided leads were completely removed with the help of femoral snare. Ten (5%) patients had at least one major perioperative complication: 3 cardiac tamponades, 1 haemothorax, 1 stroke, 5 vascular breaches requiring surgical intervention. No in-hospital death was observed. Conclusion Our large scale retrospective study in 4 high-volume mechanical lead extraction centres shows that TightRail is highly effective for chronically implanted lead extraction. The safety profile appears similar to the rate recently described with power sheaths.