LAUSR

Introduction Lead extraction has emerged as an important procedure for upgrading devices by maintaining venous access and removing redundant leads. Although most lead extractions are performed percutaneously, hybrid approaches that involve minimally invasive surgical techniques along with percutaneous extraction have been reported. In rare circumstances, patients may require open heart surgery for valvular dysfunction, which affords the opportunity for concomitant lead extraction and reimplantation. The approach to lead management in these clinical situations can be complex and must be individualized. We report a unique clinical dilemma of a patient with congenitally corrected transposition of the great arteries (cc-TGA) whose medical course was complicated by complete heart block necessitating transvenous dualchamber pacemaker implantation in childhood. He later developed severe systemic atrioventricular valve (tricuspid valve [TV]) regurgitation complicated by systemic ventricular dysfunction requiring surgical TV replacement and lead extraction with upgrade to a biventricular implantable cardioverter-defibrillator (BiV-ICD). In this report, we describe the rationale and approach for safely and effectively performing these procedures in a hybrid manner.