Heart Institute Becomes Center of Excellence for Laser-Assisted Lead Extraction

The   Cooper   Heart   Institute,   one of the premier arrhythmia management programs in the region, has recently been selected as one of 12 Centers of Excellence in the nation for laser-assisted endocardial lead extraction. Laser technology has transformed the safety and efficacy of transvenous  cardiac  pacing  lead  removal for  the  nearly  10,000  patients  annually who  require extraction, a  procedure  long associated  with a  high  incidence of  life- threatening complications.

Institutions and teams are  chosen  as Centers of Excellence by exhibiting the highest standard of practice, predictable outcomes, and world-class medical care in laser lead extraction and lead management.

In addition,  a  Center of  Excellence must  also include a  multi-disciplinary health care team, led by the extracting electrophysiologist who manages all aspects of a patient’s lead.

Led by John A. Andriulli, DO, Director of the Cooper Electrophysiology Laboratory and Arrhythmia Device Program, the Cooper program provides outside physicians and their teams with didactic and observational training for laser lead extraction.

“Cooper has a uniquely dedicated team that includes an electrophysiologist, a CT  surgeon, CT  anesthesiologist, perfusionist,  and  CT and  EP  nurses   to perform the laser-assisted lead extraction,” says  Dr.  Andriulli.  “Outcomes in  lead extraction are closely linked to expertise and experience. At Cooper we have performed  over 150 extractions since our program  began  in  mid 2010,  without  a single serious complication, more than any other institution in New Jersey.”

The need for safe, effective lead extraction has risen as the  use  of  device implantation for arrhythmia management has increased. The Heart Rhythm  Society (HRS) Class I indications for lead extraction remain limited to:

  • Infection,     defined     as     documented system  infection  evidenced by  valvular endocarditis, lead endocarditis, or sepsis, as well as patients with evidence of pocket infection, pocket abscess, device erosion, and skin adherence.
  • Life-threatening  arrhythmias  secondary to retained leads or lead fragments in functional or non-functional leads.
  • Endocardial  leads  that  due  to  their design, fracture or failure, may pose an immediate threat to the patient if left in place.
  • Retained leads that interfere with the operation of implanted cardiac devices.

 Onsite cardiac surgery back-up is required to  perform  laser lead extraction, and, until recently, all extraction procedures have been performed in the Cooper operating suites. However, extensive technological upgrades have been completed to enable laser  lead  removal  cases  to  be  moved from the Cooper operating suites to the new hybrid catheterization laboratory.

“To perform  lead  extraction  outside of the operating room setting, the lab needed to be retro-fitted to accommodate cardio-pulmonary bypass and advanced anesthesia capabilities,” says Dr. Andriulli. “Cardiac anesthesia at Cooper is under the direction of  Muhammad Muntazar, MD, and staff, and is the finest in the Delaware Valley.  The  combination of  exceptional anesthesia expertise, renovated laboratory facilities  and highly-trained  staff  provides a setting at Cooper to perform procedures on the most complex patients.”

For more informatioabout laselead extractioor to refer a patient for consultation, please cal856.342.2034.



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