A lead extraction procedure commenced to remove a right ventricular (rv) and a right atrial (ra) lead due to rv lead malfunction and due to patient's ejection fraction (ef) being >70%, it was thought that if the leads were removed, that the patient might not any longer need them.Spectranetics lead locking devices (ldl's) were placed within each lead to provide traction during lead removal.The case began with the surgeon using a spectranetics 14f glide light laser sheath to extract the ra lead; ultimately the ra lead released, retracted into the glidelight's sheath, and was removed.Significant scarring was noted around this lead, resembling a ''sleeve'' of scar tissue (both ra and rv leads were implanted on (b)(6) 2010).However, while calibrating a 16f glidelight device to begin working on the rv lead, transesophageal echo-cardiograhy (tee) revealed a growing effusion.The surgeon was scrubbed in for the case and performed a partial sternotomy in hope that a full sternotomy wouldn't be needed, since the effusion stopped growing.However, the decision was made to perform a full sternotomy and a perforation of the ra was noted.Repair to the area was successfully made.From the pocket (and while the chest remained open), a 16f glidelight device was used to attempt to free the rv lead; however progress stalled in the subclavian region due to significant scarring.The physician then chose a spectranetics 13f tight rail sub-c rotating dilator sheath that successfully made it to the innominate region.However, the surgeon noted bleeding from the patient's chest and an innominate injury was quickly discovered.The tight rail sub-c was removed.It was a difficult repair; it was determined that the patient's saphenous vein would not work for repair, so the area was repaired using bovine pericardium.At that point, the team chose not to remove the rv lead, with the thought that there would likely be additional scarring down the rv lead.The rv lead (with the lld remaining inside the lead) was cut and capped and left within the patient.The physician did not attempt to unlock the lld in the rv lead prior to cutting and capping.After the procedure, there was concern as to whether or not the bovine pericardium patch was holding; the patient was transferred while on extracorporeal membrane oxygenation (ecmo) to a larger facility in san francisco for further follow up.The patient ultimately died on 30 october 2020.This report captures the lld with was present in the rv lead and was cut and capped and left in the patient.Mdr 1721279-2020-00235 captures the ra perforation that occurred when the lld was providing traction within the ra lead, and mdr 1721279-2020-00236 captures the innominate injury which occurred during use of the spectranetics tight rail device along with the patient's death, which occurred two days post procedure.There was no alleged malfunction of any spectranetics device in use during the procedure.
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