Combination of Intravascular Lead Extraction and Epicardial Lead Placement During Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Background: Thrombus formation and pulmonary thromboembolism are recognized complications of transvenous cardiac implantable electronic devices (CIEDs).Although the pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is complex, incidental CIED lead thrombi have been confirmed in patients with concomitant CTEPH despite chronic anticoagulation therapy.To reduce the risk of recurrent thrombosis, we performed intravascular lead extraction and epicardial CIED lead placement during pulmonary endarterectomy (PEA) for CTEPH.We present a consecutive case series.Methods: A retrospective medical record review was conducted for the patients undergoing PEA and epicardial CIED lead conversion at our institution between 2020 and 2024.Preoperative, intraoperative and postoperative data were collected.