Prognosis associated with redo cardiac resynchronization therapy following complete device and lead extraction due to device-related infection

Abstract

Redo CRT implantation after device extraction owing to device-related infection has a low success rate and shows a higher rate of re-infection than that observed in patients who undergo CRT implantation for the first time. Further, patients whose blood cultures are positive for S. aureus show a particularly poor outcome.

Prognostic Value of Preoperative Echocardiographic Findings in Patients Undergoing Transvenous Lead Extraction

“…The present study set out to investigate the usefulness of preoperative transesophageal echocardiography in the assessment of the long-term survival after TLE. The results are consistent with those observed in earlier studies [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] which showed that patient-dependent variables (demographic, related to the underlying disease, comorbidities, systemic infection) were the main risk factors for death at long-term follow-up. CIED-related factors, including the number of leads, left ventricular lead and ICD lead play a significant role, but secondary to the underlying condition [ 5 , 6 , 11 , 12 , 13 , 14 , 15 , 19 , 21 ].…”

“…Vegetations and LRIE have always been (in all previous analyses, including ours) one of the most potent factors decreasing chances of long-term survival [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Unfortunately, despite the improving standards [ 2 , 3 , 4 ] long-term mortality among patients after TLE performed due to LRIE does not improve as desired.…”

“…The available evidence shows that CIED-related infection is the most common prognostic factor for unfavorable outcomes of TLE [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 ]. Other factors are mainly those dependent on the patient’s general condition i.e., age [ 6 , 13 , 21 , 22 ], renal failure [ 5 , 6 , 7 , 8 , 10 , 12 , 13 , 16 , 19 , 20 , 21 , 22 ], diabetes [ 5 , 16 , 21 ], heart failure [ 7 , 10 , 16 , 22 ], anemia [ 8 , 19 ], comorbidities [ 7 ]. Several studies have demonstrated the significance of procedure-related factors (system upgrade, ICD or CRT device, procedural failure, retained lead fragments, major complications, abandoned leads) [ 5 , 6 , 11 , 12 , 13 , 14 , 16 , 21 ] ( Table 5 ).…”

“…Therefore, theoretically the fate of patients after TLE should not differ from those who did not undergo TLE. There is a large volume of published studies describing TLE outcomes, however the results are still unsatisfactory, because mortality is 5–25% at one year, 8–38% at three years, 8–44% at 5 years and 10–60% at 10 years, with the lowest values encountered in patients with non-infectious indications and highest in those with lead-related infective endocarditis (LRIE) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Previous studies have not analyzed the effect of echocardiographic phenomena on long-term survival of patients undergoing TLE, and few reports have only assessed their relationship with the risk of procedure.…”

Sondenlose endokardiale linksventrikuläre Stimulation

“…Verschlossene Zugangswege der Vv. subclaviae, der V. cava superior oder einer geeigneten CS-Vene sind häufig Gründe dafür [29][30][31]. Alternative CRT-Verfahren, unabhängig von den klassischen Zugangswegen, sind in diesen Szenarien immer attraktiv.…”