Surgical management of infected cardiac implantable electronic devices

Chaudhry, Umar; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Christina; Tsipas, Pantelis; Kokotsakis, John; Athanasiou, Thanos

doi:10.1016/j.ijcard.2015.11.013

Cited by 8 publications

(5 citation statements)

References 50 publications

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“…After TLE, lead tips and CIED were sent for culturing. To minimize the risk of CIEDI recurrence, combined TLE and CIED re-implantation procedure was performed only in PM-dependent patients, preferentially using an epicardial approach [14], while the other procedures were delayed, according to current guidelines [15].…”

Section: Cied Infection Managementmentioning

confidence: 99%

The “Subtle” connection between development of cardiac implantable electrical device infection and survival after complete system removal: An observational prospective multicenter study

Diemberger

Migliore

Biffi

et al. 2018

International Journal of Cardiology

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Section: Cied Infection Managementmentioning

confidence: 99%

The “Subtle” connection between development of cardiac implantable electrical device infection and survival after complete system removal: An observational prospective multicenter study

Diemberger

Migliore

Biffi

et al. 2018

International Journal of Cardiology

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“…6,8-10 Expert statements and previous studies have defined highrisk patients for transvenous lead extraction. 6,8-10, 18 Indications for open heart surgery are failed transvenous lead extraction and leads attached to large vegetations. 17 In ICD and pacing leads, transvenous lead extraction can fail due to long-dwelling leads (≥10 years).…”

Section: Surgical Approach For Unsuitable Isolated Cied Lead Extractionmentioning

confidence: 99%

Surgical Management of Cardiac Implantable Electronic Device Complications in Patients Unsuitable for Transvenous Lead Extraction

Miyagi

Oomori

Maeda

et al. 2022

Circ J

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Background: Although surgical approaches for infected or failing cardiac implantable electronic device (CIED) leads are more invasive than transvenous approaches, they are still required for patients considered unsuitable for transvenous procedures. In this study, surgical management with transvenous equipment for CIED complications was examined in patients unsuitable for transvenous lead extraction. Methods and Results:We retrospectively examined 152 consecutive patients who underwent CIED extraction between April 2009 and December 2021 at the Department of Cardiovascular Surgery, Nippon Medical School. Nine patients (5.9%; mean [±SD] age 61.7±16.7 years) who underwent open heart surgery were identified as unsuitable for the isolated transvenous approach. CIED types included 5 pacemakers and 4 implantable cardioverter-defibrillators; the mean [±SD] lead age was 19.5±7.0 years. Indications for surgical management according to Heart Rhythm Society guidelines included failed prior to transvenous CIED extraction (n=6), intracardiac vegetation (n=2), and severe lead adhesion (n=1). Transvenous CIED extraction tools were used in all patients during or before surgery. Additional surgical procedures with CIED extraction included epicardial lead implantation (n=4) and tricuspid valve repair (n=3). All patients were discharged; during the follow-up period (mean 5.7±3.7 years), only 1 patient died (non-cardiac cause).Conclusions: Surgical procedures and transvenous extraction tools were combined in the removal strategy for efficacious surgical management of CIED leads. Intensive surgical procedures were safely performed in patients unsuitable for transvenous extraction.

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“…With regards to the approach to CIED removal, the percutaneous technique has emerged as the initial and preferred approach, even in patients with vegetations >10–20 mm in size , as long as it is performed in an experienced and recognized center with available cardiovascular surgical back‐up . An open surgical approach may be needed in patients with very large (>20–30 mm) lead‐associated vegetations, in cases of failed, incomplete, or complicated percutaneous removal or when valve or other cardiac surgery is indicated for other reasons . Both removal techniques incur complications, including death .…”

Section: Cied Removal and Lead Extractionmentioning

confidence: 99%

Managing infected cardiovascular implantable electronic devices

Manolis¹,

Melita

2016

Continuing Cardiol Educ

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The number of cardiac implantable electronic device (CIED) implants is growing; unfortunately, the rate of device infections is also rising, outpacing the increase in device implantation and paralleling the complexity of current CIEDs and CIED recipients, incurring high morbidity and mortality, long hospital stays, and increased financial cost. For either pocket or lead infection, percutaneous complete removal of the infected device and lead system combined with prolonged antibiotic treatment is the standard approach to patient management. A variety of mechanical and/or laser‐assisted techniques and tools are employed with high success rates in experienced centers. Surgery is reserved for cases with very large vegetations, need for other concomitant cardiac surgery or for failed or complicated percutaneous approach. Following removal of an infected CIED, the need for reimplantation of a new device is individualized, although the timing is variable, mainly based on the absence of signs of continued infection. In general, CIED‐related infective endocarditis and the presence of comorbid conditions are associated with increased mortality. These and other important relevant issues of contemporary management of patients with infected CIEDs are herein reviewed. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4596336/Activity.aspx

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Surgical management of infected cardiac implantable electronic devices

Cited by 8 publications

References 50 publications

The “Subtle” connection between development of cardiac implantable electrical device infection and survival after complete system removal: An observational prospective multicenter study

The “Subtle” connection between development of cardiac implantable electrical device infection and survival after complete system removal: An observational prospective multicenter study

Surgical Management of Cardiac Implantable Electronic Device Complications in Patients Unsuitable for Transvenous Lead Extraction

Managing infected cardiovascular implantable electronic devices

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