Surgery to move existing pacemaker deeper in chest

Hi everyone,

I'm 91 years old, I'm new to this group and had my 4th pacer placed (Medtronic) almost 2 years ago using the existing leads(not metronic) which are almost 35 years old. It's a dual chamber pacer. Two weeks ago I visited a vein doctor to discuss my leg swelling. He gave me some advice which was helpful and he also took a look at my pacer. He is a well known cardiac thoracic surgeon at a hospital that specializes in heart conditions and heart surgery. He's not the doctor who placed the pacer. The thoracic surgeon told me that my pacer has one or two weak points with only a thin covering of skin and if the pacer pops out it could become infected and antiobiotics won't help and it would require major surgery. I do have thin skin everywhere and I have lost about 7-8 pounds over the past year. He suggested surgery to move the pacer deeper in my chest and described the procedure without going into too much detail. I called to get more details and the PA told me they remove the pacer and existing leads, replace the pacer under pectoral muscle. She said it's not a major procedure--takes about an hour--not open heart surgery and short, often painless recovery time. I have another appointment with the surgeon to discuss it further and because of my age I'm still thinking about it. My concerns are--my pacer leads will require extraction and I'm sure there is quite a lot of scar tissue around my two right chambers and age and difficulty might be a problem. In addition the present leads have a thin covering as well. I'm concerned about the risks vs gain. I ahve an anxiety disorder, kidney issues, walk with a walker but otherwise in reasonable health---althought any surgery and recovery time will be a major emotional issue---I would hate to go through it unless absolutely necessary. My heart doctor (not a surgeon) suggested the surgery would be the right thing. I told him I didn't think I was going to do it. He suggested I be careful not to bruise the area. I'm still on the fence with this surgery and have some time to think about it--any thoughts or input or personal experience would be welcomed.

rxrich

 

5 Comments

new hardware?

by Tracey_E - 2021-10-14 16:26:30

They should be able to relocate it deeper without extraction and replacing any hardware. I would not describe extraction as a simple procedure, could you have misunderstood? ( or maybe I'm reading it wrong?)

If you are at risk of infection and they can simply put it deeper, yes I would definitely go for it. 

I believe you are the first member over 60 who has been paced long term. And I'm pretty sure that's one of the oldest, if not the oldest, set of working leads. How awesome. Nice to meet you!!! I'm at 28 years paced, still using one original lead. I hope I'm still happily pacing along at 91. 

 

Surgery to move existing pacemaker deeper in chest

by Rxrich - 2021-10-14 21:01:05

nk you for your response. I went to this doctor for advic for my lymphedma. That worked out okay. He looked at my Medtronic pacemaker since he was also a thoracic surgeon and has a good reputation. He went over the surgery briefly. Says he does it often but a f ew days later II wanted more details. I spoke to the PA on the phone who told me they make 2 insisions, remove the pacer and the leads and move the pacer that was in my chest to under the pectoral muscle. When I researched the lead extraction process I learned that they use special tools to remove the existing leads. I was concerned because after almost 35 years a good deal of scar tissue must have developed around the leads. (which are not Medtronic)  The doctor had limited information. I just told him it was my 4th pacer--placed on 3/25/20. I have another appointment with him on ther 21st to REALLY get a handle on this surgery directly from the doctor. I trust him. I'll be 92 in August 2022 and I'm considering wheteher to do the surgery or not. For me, it's an emotional issue as well. I don't want to have to go through surgery/recovery/healing etc---my cardiologist told me if my pacemaker pops out there is danger of infection and when I told him I didnt think I wanted to do this surgery he said--if you don't do it just be careful you don't bruise the area. "I know what I got and don't know what I'm getting" if it's minimally invasion with a short recovery that maight influence my decision. This is a great website. All have something ijn common.

lead removal

by Tracey_E - 2021-10-14 21:41:23

Removing 35 year old leads is NOT a simple surgery and I would not let just anyone do it. You want a specialist who does more than a hundred a year. But if your leads are functioning, I would not mess with them!!! I'm no doctor but I don't know why he can't just shift the box around, extraction seems like a lot of overkill to me. Trust him or not, I would get a second opinion. 

I see you are in Jupiter. May I ask who you saw? Message me privately if you prefer to posting publicly. I'm in Palm Beach County also. My leads are also very old. I saw one surgeon locally who didn't bat an eye at taking them out when one of mine went bad in 2010, wanted to extract and start fresh. I got a second opinion and ultimately chose to add a new lead and put off extraction. The second lead, the one he wanted to take out, is still working! I saw another doctor who specializes in extraction, an ep out of Miami, and he said when the time comes for me he's sending me to someone else more specialized than he is, someone who does more high risk lead removals. Yes, the procedure is much less risky than it was even 5 years ago, but with very old leads, we have a higher degree of risk and it's considerably more complicated. To the best of my knowledge, no one in Palm Beach or Martin County has that kind of experience. I expect to go to Miami when the time comes. 

Simply moving it is minimally invasive and very low risk. Removing the hardware and starting fresh is something entirely different. 

Lead removal

by jfbuffy - 2021-10-15 04:38:11

My experience in life is generally when I have trouble making a decision it's because I don't have enough information. Opinion shopping can be a good idea and  so can getting more opinions from expert Doctors who really know their stuff. I like what Tracey had to say everything she said sure made good sense to me. But I what do I know ? 

Old lead stays in

by maureen.coxsey - 2021-10-15 07:32:06

Hi

I had my pm put deeper under the muscle, my leads were 27 years old,unfortunately one broke while having my pm redone,so the surgeon popped another one in,he tied off the old leads stitched it behind the pm and off I went, removing a lead after so long is a big op and can cause damage so most surgeon won't remove them unless it imperative take advice from your surgeon. 

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