How do you find a surgeon who does lead extractions regularly?

Hi

My husband is set for lead extraction after Thanksgiving. His surgeon is the only one in the EP practice here who performs lead extraction. He says he has been doing them for years and recently extracted 30-year-old leads.

However, he probably does this procedure maybe twice a month, not the once or twice a week that many people seem to recommend as optimal.

Three questions:

1. Would you feel comfortable getting a lead extraction done by a surgeon who performs this surgery once or twice a month?

2. If not, how do you find a surgeon who does lead extraction more frequently? Are there published statistics or a database to consult?

3. Would you rather travel to another state to find someone who does the procedure regularly? We were thinking Duke University, but it's an 8-hour drive, and I'm concerned about how after-care would work once we return home.

Thanks!!

6 Comments

you need a comfort level

by godrew - 2023-11-06 12:49:35

I can only answer #3.  I would absolutely travel for a procedure if it made me mentally more comfortable heading into surgery.  I had a myectomy for HCM about 12 years ago and at the time there were no "Cardiomyopathy Centers of Excellence" near me in NJ. So I traveled to Massachusetts to have my procedure with a surgeon that had much experience than anyone more local and convinient to me. 

 5 hour ride and also 5 hour rides for follow ups.  I didnt care about the drive because I felt the team cutting me was the better option than being local.  You and your husbands mental health going into a procedure are very important.  

Just my opinion 

Yes I would feel happy

by Gemita - 2023-11-06 14:22:39

You state that your husband is set for lead extraction after Thanksgiving and that his surgeon is the only one in the EP practice who performs lead extractions.  He has been doing them for years and recently extracted 30-year-old leads.  That sounds like a good surgeon to me and your husband’s history will of course be well known to the practice.  There is a lot to be said for that as well.  

I would feel very happy with him, especially if you trust him?  I feel once or twice a month is still “experience”.  Did the surgeon “successfully” perform the 30 year old lead extraction by chance?  Ask and ask whether there were any complications?  That would be a good indication of his ability.

To get a referral to another surgeon and to travel perhaps hundreds or even thousands of miles wouldn’t suit me at all.  Sometimes local is best with a surgeon and team who will know your history.  The choice is yours of course and I wish you both all the very best and hope the extraction goes well

What the BHRS says

by Penguin - 2023-11-06 16:04:11

This document from the British Heart Rhythm Society explains what is expected of a UK centre that wants to offer lead extraction. 

It goes into more detail than you need but it explains what a centre needs to do / have in terms of equipment / facilities to be able to offer lead extraction.  

Our standards in the UK may differ to yours.  

https://bhrs.com/wp-content/uploads/2019/03/BHRS-Standards-Lead-Extraction-December-2018.pdf

I think I'd want to know which of the categories of risk (low / medium / high) relate to your husband's case prior to making a decision and, as Gemita says, I would want to know about outcomes alongside the number of operations performed which are low / medium / high risk.  

I wish you both all the best. I would be worried too, although I understand that these operations are now commonplace.  

Good luck x 

Experience and precaution

by USMC-Pacer - 2023-11-06 19:20:34

My EP here in the Boston area has done 1000s according to his staff. He did a great job on me and I was comfortable with him. He also always has a cardiothoracic surgeon in the room with him "just in case." He claims he has never needed it, but if things go South?? He removed my 2 leads after 10 years that were scar tissued and entangled. 

Lead Extraction

by Julros - 2023-11-06 23:24:14

I had a lead extracted by an EP recommended by my usual EP, because not only does she do them, but she teaches others. She does them at a major teachig hospital. As USMC-Pacer said, there was a cardiothoracic surgeon in the room just in case, along with a room full of personnel, and equipment. She was prepared to use a laser, if necessary, because I had scarring around the wire in my subclavian vein, but she was able to extract my RV lead without complication. She does them once a month, up to 2 on the day she does them. She is doing my sister's in December. I was able to follow up with my regular EP, which was basically just a wound check with the office nurse. 

Ask

by Good Dog - 2023-11-07 20:23:15

The answer to your question is simple. Simply ask your regular Cardiologist/EP. You want a doc that has performed at least 100 of them. How many has the surgeon you mentioned performed? He certainly seems to be qualified. It isn't just the Doc, but also the hospital that is important. A hospital with many different surgeons that perform extractions is really important too. They will be best equipped and knowledgeable to handle anything. You can also do some simple Google searches on lead extraction and hospitals that specialize in them. If you want the best (or at least one of the best), I would suggest a 6 hour drive to the Cleveland Clinic, they do thousands (copy and paste):

https://www.google.com/maps/dir/Cleveland+Clinic+Main+Campus,+Euclid+Avenue,+Cleveland,+OH/Warrenton,+VA/@40.0806051,-82.3630996,7z/data=!3m1!4b1!4m13!4m12!1m5!1m1!1s0x8830fb9a2ad7ef19:0x1e2aa74bab017bd0!2m2!1d-81.6200078!2d41.5031026!1m5!1m1!1s0x89b67c76fc23ecff:0xdbefeebc5d83a233!2m2!1d-77.7952712!2d38.7134516?entry=ttu

If you have an interest I'd be happy to provide more specifics. Just PM me.

Sincerely,

Dave

 

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