A relevant Byrd dilator sheath damage during transvenous lead extraction – the rare phenomenon with potentially serious consequences
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Department of Cardiology, Medical University of Lublin, Poland
Acute Cardiac Care Unit, Acute Cardiac Care Unit, Świętokrzyskie Cardiology Center, Kielce, Poland
I Clinical Department of Paediatrics, Swietokrzyskie Paediatrics Center, Kielce, Poland
Department of Health Sciences, The Jan Kochanowski University, Kielce, Poland
II Cardiology Clinic, Swietokrzyskie Cardology Center, Kielce, Poland
Maciej Polewczyk   

Acute Cardiac Care Unit, Acute Cardiac Care Unit, Świętokrzyskie Cardiology Center, Kielce, Poland, ul. Grunwaldzka 45, 25-736 Kielce, Poland
Publication date: 2017-03-20
Heart Beat 2017;2:1–8
Conventional mechanical systems still remain popular as a basic tool for transvenous lead extraction (TLE). Polypropylene sheaths (Byrd dilator sheaths®) and their damage (BDD) appear to be only a phenomenon.

Material and methods:
Retrospective analysis of the 8-year experience of reference TLE Centre.

We have extracted 2901 ingrown endocardial leads in 1728 patients (only mechanical systems utilised revealed). Analysis showed, that BDD occurs rarely (2,2% procedures, 1,3% extracted leads). It was observed most often in superior vena cava (43,6%). 79,5% damages were eliminated by covering the broken inner sheath with outer sheath and their common removal. In 10,2% cases wider tube was introduced over the damaged one and extracted at the end of the procedure with the lead. BDD was observed more frequently in younger patients, in those with more implanted leads, with longer lead body dwelling time, with unnecessary lead loops and with leads on both sides of the chest. BDD may be connected with the phenomenon of lead-to-lead adherence and TLE from right subclavian approach. Although BDD concerned more difficult procedures, complications rate in these cases was not significantly higher.

BDD (excluding blunting of the sheath edge) occurs in about 2% of TLE procedures. Only damages followed by sheath lumen closure, or rupture remain problematic. BDD occurs in patients with numerous procedural risk factors - more extracted leads, lead loops, longer lead dwelling time.BDD does not have influence on TLE effectiveness but results in procedure prolongation. The operator should observe total course of the sheath all the time.