Publications by authors named "Gregory Cranney"

10 Publications

  • Page 1 of 1

Characterisation of Rare Left Partial Anomalous Pulmonary Venous Connection.

Heart Lung Circ 2020 Nov 20. Epub 2020 Nov 20.

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.

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http://dx.doi.org/10.1016/j.hlc.2020.10.021DOI Listing
November 2020

Lead Extraction for Treatment of Cardiac Device Infection: A 20-Year Single Centre Experience.

Heart Lung Circ 2017 Mar 12;26(3):240-245. Epub 2016 Aug 12.

Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia.

Background: Infection is one of the most feared complications of cardiac implantable electronic devices. We report microbiology, antimicrobial therapy and infection recurrence in patients with cardiac device infection (CDI) treated with transvenous lead extraction (TLE) at a single centre over a 20-year period.

Methods: We identified a cohort of consecutive patients undergoing TLE for CDI by a single operator at a single high volume centre. Retrospective analysis of patient characteristics, microbiology, outcomes and infection recurrence was performed.

Results: Between May 1992 to March 2012, 348 patients underwent extraction due to localised or systemic infection. Seven hundred and twenty leads were extracted from these patients. The mean follow-up was 5.5+/-4.9 years. Staphylococcal species accounted for 81% of CDI. A difference is seen in infection onset for device revision compared with initial implants [median 10 months vs 24 months, P=0.0001]. Duration of antibiotics therapy depended on the nature of the CDI (21 days post TLE for systemic vs. 10 days for localised infection, P < 0.0001). There was comparable mortality in the 37 (11.2%) patients who did not have a replacement device compared with a replacement (30% vs 29%, P=0.9). Retained lead fragments are a risk factor for CDI recurrence (20.8% recurrence in retained fragments vs 4.3% in complete removal, P=0.006).

Conclusion: Cardiac device infection can be successfully treated with a combination of TLE and antibiotic therapy. Device therapy can be safely withdrawn in some patients. Retained lead fragments are a risk factor for recurrent CDI following extraction.
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http://dx.doi.org/10.1016/j.hlc.2016.06.1217DOI Listing
March 2017

Long-Term Outcomes Following Transvenous Lead Extraction.

Pacing Clin Electrophysiol 2016 Apr 18;39(4):345-51. Epub 2016 Feb 18.

Eastern Heart Clinic, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.

Background: Complications related to a cardiac implantable electronic device sometimes require transvenous lead extraction (TLE). We report long-term follow-up of patients undergoing TLE, particularly mortality, recurrent device infection, and need for repeat procedures.

Methods And Results: Consecutive patients undergoing TLE at a high-volume center were assessed for characteristics, indications, and outcomes. One thousand and six leads were extracted from 510 patients. Clinical success rate was 98.2% and complete procedural success was 92.2%, with one intraprocedural death. The mean follow-up was 5.5 +/- 4.9 years (range 0.2-18 years). Cumulative mortality was 3.3% at 30 days, 7.7% at 6 months, 10.0% at 1 year, and 33.0% at 10 years. Factors associated with increased long-term mortality included cardiac device infection (CDI; 33% vs 17% for non-CDI; χ² 13.8, P = 0.0003), procedural complications (43% vs 27% for no complications; χ² 4.2, P = 0.04), age (75.0 +/- 10.9 years in patients who died vs 62.7 +/- 17.2 years; P < 0.0001), and impaired renal function (creatinine 142.5 +/- 106.4 μmol/L in patients who died vs 106.3 +/- 90.7 μmol/L; P = 0.001). The rate of CDI after TLE was 3.9% (mean 11.6 months post extraction, range 0.3-84 months) and is higher in patients with retained lead fragments (13.5% vs 3.0% with complete removal; χ² 10.7, P = 0.001).

Conclusion: Long-term mortality following TLE is high, particularly in those with systemic infection, procedural complications, advanced age, and renal impairment. Retained fragments are a risk factor for CDI post extraction.
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http://dx.doi.org/10.1111/pace.12812DOI Listing
April 2016

Complete Angiographic Resolution of Cocaine Induced Coronary Artery Dissection within Eight Days without Coronary Stenting--A Case Report.

Heart Lung Circ 2016 Feb 15;25(2):e24-8. Epub 2015 Jul 15.

Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address:

Introduction: Coronary dissection is a rarely reported complication of cocaine use for which there are no specific guidelines on management despite the widespread use of the drug.

Methods: We report a case of a 26-year-old otherwise fit and healthy Caucasian male smoker who presented to our facility with an infero-lateral ST elevation myocardial infarction (STEMI) following nasal inhalation of 1 gram of cocaine. Coronary angiography showed a mid left anterior descending (LAD) artery dissection with distal occlusive embolism and another dissection of the distal right coronary artery (RCA) with embolism and occlusion of the distal posterolateral branch.

Outcome: Wiring of both vessels with a High-Torque Floppy wire successfully re-established TIMI 3 flow with relief of pain and resolution of his ST-segment elevation. Given the absence of any flow-limiting lesions, stenting was avoided. He was subsequently put on a combination of therapeutic dose enoxaparin, aspirin, ticagrelor, atorvastatin and metoprolol. A repeat angiogram eight days later showed complete healing of the dissections.

Conclusion: This case shows that percutaneous management without stenting coupled with aggressive anti-coagulation of cocaine induced coronary dissection may result in an acceptable outcome especially in a young otherwise fit and healthy patient.
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http://dx.doi.org/10.1016/j.hlc.2015.06.829DOI Listing
February 2016

Paradoxical cardiac and cerebral arterial gas embolus during percutaneous lead extraction in a patient with a patent foramen ovale.

Heart Lung Circ 2015 Jan 16;24(1):e14-7. Epub 2014 Sep 16.

Eastern Heart Clinic, Prince of Wales Hospital, Barker Street, Randwick 2023, Australia.

A 42 year-old man presented for elective percutaneous lead extraction for pacemaker redundancy. The procedure was performed supine under general anaesthesia via the right femoral vein and was complicated by acute inferior ST elevation and hypotension. Urgent transoesophageal echocardiogram showed inferior left ventricular hypokinesis, right ventricular impairment, a patent foramen ovale and air in the left ventricle. Coronary angiography demonstrated normal coronary arteries, the ST changes resolved and the leads were subsequently removed intact. Post-operatively the patient displayed nystagmus, was managed with hyperbaric oxygen therapy, and had complete resolution of his symptoms. An MRI brain confirmed an acute left cerebellar infarction, and a diagnosis of paradoxical air embolus to the coronary and cerebral circulations was made. This case illustrates the risks associated with paradoxical embolism in patients with PFOs undertaking percutaneous lead extractions. It also highlights the need for further consideration into techniques to avoid this complication in all high-risk percutaneous procedures.
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http://dx.doi.org/10.1016/j.hlc.2014.09.002DOI Listing
January 2015

Twenty-year experience of transvenous lead extraction at a single centre.

Europace 2014 Sep 19;16(9):1350-5. Epub 2014 Feb 19.

Department of Cardiology, Prince of Wales Hospital, Sydney 2031, Australia.

Aims: Indications for cardiovascular implantable electronic devices continue to evolve, which has led to an increasing requirement for transvenous lead extraction. We explore the indications, complications, and success rates involved in the removal of pacemaker and implantable cardioverter-defibrillator (ICD) leads in a high-volume centre, over 20 years.

Methods And Results: We performed a retrospective analysis of all consecutive patients undergoing transvenous lead extraction by a single operator at a single centre between 1993 and 2012. Patient characteristics, indications, and outcomes were analysed. A total of 1006 leads were removed from 510 patients. Seventy-two per cent of patients were males. The mean age was 64 years (range 14-96). Indications included systemic infection (25%), pocket infection (40%), lead failure (26%), chronic pain (3%), and other (6%). Ninety-six per cent of leads were completely removed. There was one procedure-related death, and the major complication rate was 0.3%. Infection was the only identified predictor of increased complication (χ² for difference between groups 20, P< 0.0001).

Conclusion: Pacing and ICD leads can be safely extracted with mechanical techniques. The presence of device infection appears to be the major predictor of procedural complications.
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http://dx.doi.org/10.1093/europace/eut424DOI Listing
September 2014

Impending paradoxical embolism: have we lost the clot?

Clin Respir J 2014 Oct 20;8(4):460-2. Epub 2014 Jan 20.

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia.

Impending paradoxical embolism is a rare diagnosis that requires urgent treatment. We present a case where surgical thromboembolectomy was undertaken. The thrombus vanished from view on transesophageal ultrasound and was presumed to have undergone embolisation while bypass was established. Unexpectedly, it was found tangled in the superior vena cava cannula apertures.
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http://dx.doi.org/10.1111/crj.12093DOI Listing
October 2014

Deleterious effect of nitric oxide inhibition in chronic hepatopulmonary syndrome.

Eur J Gastroenterol Hepatol 2007 Apr;19(4):341-6

Gastrointestinal and Liver Unit, The Prince of Wales Hospital and University of New South Wales, Sydney, Australia.

On the basis of limited experimental and clinical studies, increased activity of the vasodilatory nitric oxide-cyclic guanosine monophosphate pathway is considered to play a key role in the pathogenesis of hepatopulmonary syndrome. We report a 46-year-old woman with Child-Pugh class C cirrhosis and progressive dyspnoea for 12 months. Investigations revealed elevated circulating concentrations of nitric oxide metabolites and exhaled nitric oxide levels, an hyperdynamic circulation with low systemic vascular resistance and mean arterial pressure, a large right to left intrapulmonary shunt fraction on radiolabelled macroaggregated albumin perfusion scanning, positive contrast-enhanced echocardiography, reduced diffusion capacity of carbon monoxide, hypoxaemia and orthodeoxyia, all in keeping with severe hepatopulmonary syndrome. Sequential inhibition of the nitric oxide-cyclic guanosine monophosphate pathway using curcumin (diferuloylmethane), terlipressin and methylene blue was associated with substantial improvements in vascular tone and the hyperdynamic circulation. No improvement, however, in the intrapulmonary shunt was demonstrated. Both hypoxaemia and orthodeoxia were substantially, reproducibly and reversibly worsened with all three treatments. Our findings argue against the contention that intrapulmonary shunting and impairment in arterial oxygenation in hepatopulmonary syndrome are necessarily the consequence of on-going, nitric oxide-cyclic guanosine monophosphate-mediated vasodilatation, at least in the chronic stage, and, given the possibility of substantial worsening of pulmonary oxygen exchange, suggest that inhibition of the nitric oxide-cyclic guanosine monophosphate pathway should be avoided in this setting.
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http://dx.doi.org/10.1097/MEG.0b013e328014a3bfDOI Listing
April 2007

A tale of two toes.

Heart Lung Circ 2006 Aug 9;15(4):267-8. Epub 2006 Jun 9.

Prince Of Wales Hospital, Sydney, Australia.

Percutaneous closure of a patent foramen ovale (PFO) is increasingly being performed for patients with suspected paradoxical embolus. We report a rare case of a PFO occluder device related infective endocarditis.
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http://dx.doi.org/10.1016/j.hlc.2006.04.001DOI Listing
August 2006

An unusual case of partial anomalous pulmonary venous drainage.

J Am Soc Echocardiogr 2002 Sep;15(9):997-9

Department of Cardiology, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia.

We report a case of partial anomalous pulmonary venous drainage where the left upper and lower pulmonary veins drain into a separate posterior left atrial (LA) chamber before continuing as a vertical ascending vein. The vertical vein then joins the left innominate vein, which eventually drains into a normal right-sided superior vena cava. There was no fenestration or communication between this posterior chamber and the true LA. The true LA contained the fossa ovale and LA appendage. The right upper and lower pulmonary veins drain normally into the true LA. To our knowledge, this is the first case where the left upper and lower pulmonary veins drain into a separate posterior LA chamber before continuing into a vertical vein. The diagnosis was initially made with transesophageal echocardiography and confirmed by magnetic resonance imaging. The patient later underwent successful corrective operation.
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http://dx.doi.org/10.1067/mje.2002.124642DOI Listing
September 2002