Study procedures
Initially, subjects underwent a transesophageal echocardiogram and blood cultures to guide extraction and antibiotic therapy. Periprocedural anticoagulant management varied according to individual characteristics; in patients with mechanic mitral valves, warfarin was continued, and the procedure was performed with an INR 2-3, but patients on direct oral anticoagulants received the last dose at least 24 hours before the procedure. Oral anticoagulation was restarted 24 hours after the procedure if the patient did not develop a hematoma. All patients underwent complete hardware removal under general anesthesia using manual dilator sheaths (Sightrail® or Visisheath®, Spectranetics, Colorado Springs, CO, USA), mechanical rotating dilator sheaths (Tightrail®, Phillips Healthcare, Amsterdam, Netherlands), or laser-powered sheaths (Guidelight, Phillips Healthcare, Amsterdam, Netherlands) along with locking stylets (LLD, Phillips Healthcare, Amsterdam, Netherlands). Complete procedural success was defined as the removal of all targeted leads and material without permanently disabling complications or procedure-related death. Clinical success was defined as the retention of a small portion of a lead (<4 cm) that did not negatively impact the outcome goals of the procedure.(12) Tissues extracted from the generator pocket and lead tips were sent for culture. In both groups, antibiotic irrigation was discouraged, as it has not shown any improvement in procedure-related infections.(13) All procedures were approved by the institutional review board.