July 8, 2008 - Foothills Medical Centre, a leading medical centre for treating patients with cardiac rhythm abnormalities in Calgary, Alberta, has become the first facility in Canada to use the new Evolution Mechanical Dilator Sheath Set from Cook Medical for the removal of pacemaker leads, reportedly simplifying this potentially challenging medical procedure.
John Rothschild, M.D., FRCSC, a surgeon at the Libin Cardiovascular Institute who specializes in pacemaker and defibrillator surgery at the Foothills Medical Centre, has performed the first patient procedures using the Evolution Mechanical Dilator Sheath Set. Dr. Rothschild and Foothills Medical Centre are the first in Canada to adopt this system, which recently received regulatory approval for sale in Canada and the European Union.
Cardiac pacing leads connect pacemakers and defibrillators to a patient’s heart. These leads, which are implanted within the patient’s veins, are intended to deliver appropriate electrical therapy when necessary to stabilize dangerously slow or erratic heart beat. As with most implanted medical devices, cardiac leads may need to be replaced or removed during the life of a patient due to a variety of reasons. With the rise of pacemaker and defibrillator implants due to the aging population, the number of cardiac leads that will need to be replaced or removed is expected to increase.
Cardiac leads are typically removed or “extracted” through the use of special sheaths or tubes that are advanced down the length of the lead and separate the problematic lead from the binding scar tissue that may anchor it in place. One common system for removing pacemaker leads uses a laser-powered cutting sheath. But this system is costly to maintain and has clinical limitations due to the fact that the laser’s cutting edge can’t get through calcified scar (or does so only with difficulty and lengthy applications of the laser beam); it may also have difficulty following tight curves in the lead.
In contrast, Cook’s Evolution system employs a mechanical cutting sheath that rotates the cutting edge as the physician engages a special trigger in the system’s handle. This system allows the operator to precisely control the device’s threaded barrel distal tip within the vein with the objective of minimizing vascular damage.
Dr. Rothschild said the device is cost-effective and relatively simple to use.
“It hopefully will give me an increased ability to extract the more difficult (scarred) leads, reducing the need for expensive open heart surgery or sending my patients to other centres for treatment,” he said. “The Evolution requires patience and extreme care as with any other lead extraction system, but is an important addition to our surgical armamentarium. I also like the idea that the Cook system requires no capital investment and none of the costly regularly scheduled maintenance that is required by the laser system. The Evolution system will, I believe, become a significant tool for the improved and safer performance of this surgery - for our hospital, myself, the other members of the lead extraction team, and most importantly, the patient.”
For more information: www.cookmedical.com
March 26, 2024 
