Original paper
Usefulness of the Evolution mechanical dilator sheath for endocardial lead extraction – preliminary results

Background: Due to the growing use of pacemakers, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy units as well as the prolongation of life of the devices’ recipients, an increasing number of patients require lead extraction. There are several methods of transvenous extraction.
Aim: To report the first Polish experience with the new, mechanical system for lead extraction (Evolution).
Methods: Between January 2008 and April 2010 45 patients underwent extraction of 76 leads. Median implantation time was 3.3 years (range 0.1-26 years). There were 68 pacing leads and 11 ICD leads. Thirty one (41%) leads were removed with manual traction, in other cases the Byrd dilatators or femoral approach were used. The Evolution system was used only if the other methods were not successful.
Results: Seventy two (95%) leads were completely and two partially extracted. Two leads (2.5%) could not be removed. The Evolution system was used in 3 patients (6 leads, 8%). All but one lead were successfully extracted with the Evolution sheaths. There were no major complications. One patient required blood transfusion due to intraoperative bleeding (minor complication).
Conclusion: The Evolution system seems to be a safe method to improve success rates of lead extraction.