Safe and Simplified Salvage Technique for Exposed Implantable Cardiac Electronic Devices under Local Anesthesia

Abstract

BackgroundSkin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition.MethodsThe records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0–1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study.ResultsSeven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage.ConclusionsBased on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.

Successful Reimplantation of Extruded Lead after Hypoglossal Nerve Stimulation Surgery

“…Traditional management of infected and exposed CIEDs often involves surgical explantation of the entire system followed by reimplantation of a new device in a new, noninfected site. However, explantation presents its own unique cardiac complications, such as myocardial damage, subclavian perforation, and even death, so salvage of the implant is often considered 3 . Salvage techniques include surgical debridement and the creation of a new subcutaneous pocket for device placement.…”

“…However, explantation presents its own unique cardiac complications, such as myocardial damage, subclavian perforation, and even death, so salvage of the implant is often considered. 3 Salvage techniques include surgical debridement and the creation of a new subcutaneous pocket for device placement. In orthopedic literature, the salvage of exposed hardware has also been successful.…”

Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision

“…Jung et al 29 described a series of 10 patients for salvage of the same exposed CIEDs by creating a new subcutaneous pocket 1 to 1.5 cm away from the involved area under local anesthesia and using closed suction drainage. However, none of their cases had overt signs of local sepsis.…”

Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques

“…There are two draw backs to these leads. The stability issues 14 one and two the explantation 15 if it is needed due to any reasons. Tined leads instead of having active fixing materials there are small tines that protrude backward just proximal to the tip, made of plastic materials, make these leads more difficult to position at the right ventricular apex as the tines tended to anchor on intracardiac structures.…”