Conservative therapy for the management of cardiac implantable electronic device infection

Sekiguchi, Yukio

doi:10.1016/j.joa.2015.09.012

Cited by 11 publications

(6 citation statements)

References 42 publications

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“…3,4 Unlike other areas of the body where surgical removal of the infected implant can be performed, LVAD explantation is a last resort, often met with increased morbidity and mortality due to patient's heart function status. [5][6][7] Most often, surgical treatment utilizes IV antibiotics, surgical debridement, and wound care such as negative pressure wound therapy (NPWT). 4 Salvage procedures such as omental or muscle flaps are also employed for definitive closure and delivery of antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Instillation Negative Pressure Wound Therapy: A Role for Infected LVAD Salvage

Hodson

West

Poteet

et al. 2019

Advances in Wound Care

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Objective: To determine the utility of instillation negative pressure wound therapy (NPWT) in achieving eradication of infection and definitive wound closure in patients with infected left ventricular assist device (LVAD). Approach: A retrospective review was performed in a series of patients with infected and exposed LVADs who were treated with instillation NPWT in conjunction with surgical debridement. Results: Three consecutive patients were included who developed periprosthetic infection subsequent to LVAD implantation. In all cases, the utilization of a vacuum-assisted closure with instillation (VACi) along with surgical debridement and IV antibiotics eradicated infection resulting in successful retention of hardware. Cases 1 and 2 received definitive wound closure within 3 and 12 days of starting treatment, respectively. Case 3 initially deferred surgery in favor of local wound care. Eventually the patient elected for surgical treatment and underwent closure 164 days after initial presentation. All three patients healed completely without residual evidence of infection. Flap reconstruction with a pedicled rectus flap was used to achieve definitive closure in all patients. One patient subsequently required pump replacement secondary to thrombosis and mechanical pump failure. Innovation: LVAD infections are met with high morbidity and mortality rates, and timely salvage is critical. In this initial series, VACi has proven a viable therapy option to help control and eradicate infection without LVAD removal. Conclusion: This series illustrates the value of newer techniques such as VACi in combination with surgical debridement and antibiotic therapy in effectively salvaging LVADs that were infected.

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Section: Introductionmentioning

confidence: 99%

Instillation Negative Pressure Wound Therapy: A Role for Infected LVAD Salvage

Hodson

West

Poteet

et al. 2019

Advances in Wound Care

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“…While there is extensive literature on the treatment and outcomes of cardiac-implanted electronic devices, few cases have been previously reported regarding the treatment and management of SCS-associated deep SSI. 10 The few that have been reported all involve some form of removal of the SCS device, either permanently or having it relocated. 7,[11][12][13] In a majority of the deep SSI cases, only parts of the SCS device needed to be removed (most commonly the IPG and extension leads) because the epidural portion is rarely affected by the infection.…”

Section: Discussionmentioning

confidence: 99%

Dehiscence and Deep Wound Infection After Spinal Cord Stimulator Implant Managed Without Explantation: A Case Report

et al. 2022

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Deep infections of spinal cord stimulator devices usually result in explantation, as recommended by some professional societies. However, alternative options should be explored to avoid potential complications that are associated with explantation, and possibly additional procedures required in consideration of reimplantation. In this case, the patient presented with wound dehiscence after implantation. There was suspicion for deep wound infection based on a wound culture that was positive for Staphylococcus aureus, but no purulent material was noted on further inspection. The patient was treated with standard wound-care management and oral antibiotics without removing the device, and recovered while preserving the original system.

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“…Although complete cardiac implantable electronic device (CIED) system removal is initially recommended in the case of overt CIED infection, it is not necessarily required for superficial or incisional infection. 7 In the case of S-ICD, device-related blood-borne infection is considered to be rare and has not yet been reported. Therefore, if there is no overt “true” device infection, the strategy to treat wound dehiscence without removal of the device may be less harmful for patients with S-ICD than for those with TV-ICD.…”

Section: Discussionmentioning

confidence: 99%