Therapy of Cardiac Device Pocket Infections with Vacuum‐Assisted Wound Closure—Long‐Term Follow‐Up

Poller, Wolfram C.; Schwerg, Marius; Melzer, Christoph

doi:10.1111/j.1540-8159.2012.03479.x

Cited by 16 publications

(8 citation statements)

References 35 publications

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“…Centers have reported various approaches to managing isolated pocket infection in patients who refuse lead extraction. [285][286][287] Lopez et al described the use of a closed irrigation system that consisted of pulse irrigation and suction, using a solution of vancomycin and gentamycin for 72 hours following pocket debridement and washout in five patients with isolated pocket infection. Patients remained free of infection during a mean follow-up of 19 months.…”

Section: Management Of Isolated Pocket Infections In Patients Who Refuse Lead Extractionmentioning

confidence: 99%

“…Poller et al used an alternative approach to manage isolated pocket infections in five people who refused lead extraction. 287 In these cases, the generator was removed and the leads were cut, allowing them to retract into the vascular space. A vacuum-assisted wound closure dressing was placed to promote wound closure, and devices were implanted on the contralateral side when appropriate.…”

Section: Management Of Isolated Pocket Infections In Patients Who Refuse Lead Extractionmentioning

confidence: 99%

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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

et al. 2017

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†Deceased (see In Memoriam at the end of this document) *Representative of the Pediatric and Congenital Electrophysiology Society (PACES) ‡Representative of the European Heart Rhythm Association (EHRA) xRepresentative of the Society of Thoracic Surgeons (STS) {Representative of the American College of Cardiology (ACC) #Representative of the Latin American Heart Rhythm Society (LAHRS) **Representative of the Infectious Diseases Society of America (IDSA) ‡ ‡Representative of the American Heart Association (AHA) xxRepresentative of the American Society of Anesthesiologists (ASA) {{Representative of the Asia Pacific Heart Rhythm Society (APHRS)

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Section: Management Of Isolated Pocket Infections In Patients Who Refuse Lead Extractionmentioning

confidence: 99%

Section: Management Of Isolated Pocket Infections In Patients Who Refuse Lead Extractionmentioning

confidence: 99%

2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

et al. 2017

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“…There are few studies on the long-term efficacy of conservative treatment. Poller et al, Satsu et al, McGarry et al, and Zheng et al have stated that the negative pressure drainage system is effective for pacemaker pocket site infections in the long term [21,[27][28][29]. In a study of 25 case series by Bisignani et al no recurrence was observed in 24 of the patients during the 24-month follow-up period after local revision, debridement, and reimplantation [23].…”

Section: Discussionmentioning

confidence: 99%

Long-term results of conservative treatment of pacemaker pocket site infections

Eryılmaz¹,

Sivri²,

Şencan³

2022

pwki

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Introduction:The increasing frequency of cardiac device use has led to an increase in complication rates. The standard treatment for cardiac device-related infections is removal of the entire pacemaker system and reimplantation from the contralateral side after systemic antibiotherapy. The efficacy of various conservative treatments has been established for many years, but there is conflicting information in the literature regarding long-term efficacy.Aim: Our study investigated the long-term efficacy of conservative treatment in patients with pacemaker pocket site infection.Material and methods: In this retrospective study, according to the exclusion criteria, 132 patients were included. Patients were divided into conservative and standard treatment groups. Conservative treatment was considered to be opening the pacemaker pocket capsule, removing all infected and necrotic tissue, cleaning the capsule, and embedding the battery in the prepectoral region in the subpectoral muscle region.Results: The follow-up time was 36 ±12.96 months in the conservative treatment group and 39.6 ±10.8 months in the standard treatment group. During this period, no re-infection at the pacemaker pocket site was observed in either group. Examination of the swab cultures of the patients' pacemaker wounds revealed negative culture results in 15 patients (15 out of 60) in the conservative treatment group. In the standard treatment group, 60 patients (60 out of 72) were culture-negative. This difference was statistically significant (p = 0.04).Conclusions: After a rigorous evaluation, conservative treatment is considered effective and safe in the long term in patients with device pocket site infection.

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“…Following initial case reports/series, 8,9 there was a single center analysis of 28 patients with CIED pocket infections undergoing NPWT. 7 In this study, delayed primary closure occurred after a mean of 5 days with an average postoperative length of stay of 11 days.…”

Section: Contemporary Cied Pocket Infection Managementmentioning

confidence: 99%

Early modified primary closure for treatment of cardiac implantable electronic device pocket infections

Baldawi

Bogue

Mandapati

et al. 2021

Pacing Clinical Electrophis

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Background Guidance for wound management of the vacated generator pocket in cardiac implantable electronic device (CIED) pocket infections after removal of all hardware and tissue debridement is limited. The typical surgical technique for management of a purulent wound is to allow healing by secondary intention. An alternative approach uses negative pressure wound therapy with or without delayed primary closure. While effective in managing infection, these approaches increase hospital length of stay and costs. We present our experience with a third option: modified early primary wound closure over a suction device. Methods All patients with CIED pocket infections who presented to our institution between September 2018 and October 2020 underwent extraction of hardware and modified primary wound closure over a negative pressure Jackson–Pratt drain. Length of hospital and postoperative stay, complications, and recurrent infections were recorded. Results During the study period, 14 patients underwent modified primary wound closure for CIED pocket infections. Mean length of hospital stay was 6.64 days ± 4.01 days (standard deviation [SD]). Mean postoperative length of stay was 3.92 ± 2.21 days (SD). Two patients (both on intravenous heparin for mechanical valve prostheses) required re‐exploration for bleeding. No patients developed recurrent infection at a mean follow up of 363 ± 245 days (SD). Conclusion Based on our experience, early modified primary wound closure for CIED pocket infections appears to be safe and allows for prompt discharge with no observed re‐infections.

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Therapy of Cardiac Device Pocket Infections with Vacuum‐Assisted Wound Closure—Long‐Term Follow‐Up

Abstract: V.A.C. treatment may be an option for selected patients with LDI who refuse a laser-guided lead extraction or surgical removal of the electrodes as the primary therapy.

Cited by 16 publications

References 35 publications

2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction

Long-term results of conservative treatment of pacemaker pocket site infections

Early modified primary closure for treatment of cardiac implantable electronic device pocket infections

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