Background: There is a lack in clinical data regarding TLE in the western part of Switzerland.
Aim: Our registry aims to assess the characteristics and outcomes of these patients undergoing
such procedures in the canton of Vaud and to evaluate the quality of the procedures performed
at CHUV.
Methods: A total of 54 patients underwent TLE at CHUV between January 2013 and July 2021.
Their clinical and paraclinical characteristics were assessed as well as the procedural outcomes.
This is a retrospective registry including patients from the Swisslead Extraction Registry.
Results: The study population consisted in majority of male patients with multiple
comorbidities, such as hypertension, diabetes, and renal impairment. Infections were the
primary indication for TLE, accounting for 81.5% of cases.
Local infections were more frequent than systemic ones. The corresponding microbiology
differed between systemic and local infections. Systemic infections were mainly caused by S.
aureus (72.3%), whereas S. non-aureus (38.5%) was the most prevalent microorganism in local
infections. The presence of vegetations and the occurrence of sepsis were more frequently
observed in systemic infections than in local ones. Noticeably, a significant proportion of local
infections had no identifiable microorganisms. This could be attributed to slow-growing germs
such as C. acnes. Procedural outcomes and complications were also assessed, and different
extraction techniques were used depending on the type of device being extracted. A Comparison
with other registries revealed that our patients had higher rates of infections, complications, and
mortality.
Discussion: The “PADIT infection risk score”
assesses the risk of hospitalization due to CIED
infection within a year by considering several risk factors such as age, procedure type, renal
insufficiency, immune status, and the number of previous procedures. There are different
infection preventive strategies such as the TYRX envelope and hematoma management.
Major TLE-related complications were more prevalent in older patients with longer lead
dwelling times that had laser sheaths used on them. The differences between our registry and
other published ones can be attributed to our patients’ characteristics, which were more male-
dominated, older and had a higher prevalence of comorbidities.
Conclusion: this registry aimed to characterize the clinical demographics and outcomes of
patients undergoing TLE at CHUV. The findings highlight the importance of infection
prevention strategies and appropriate management of extraction techniques.