Complete removal as a routine treatment for any cardiovascular implantable electronic device–associated infection

Abstract

Complete removal of prosthetic material in any cardiovascular implantable electronic device infection is safe and associated with low morbidity and mortality. Success of eradicating infection is high if all system components are removed. Temporary pacing in dependent patients may be performed safely on an outpatient basis.

Surgical Treatment for Isolated Tricuspid Valve Endocarditis

“…Treatment usually requires complete extraction of the device and the leads. 11, 12 Del Rio et al have reported a mortality rate of surgical treatment of pacemaker and defibrillatorinduced IE as high as 12.5%. 20 History of i.v.…”

“…In patients with pacemaker lead infection, complete removal of all foreign material and extensive debridement at the site of the device pocket were done as previously described. 11, 12 In brief, after establishing the cardiopulmonary bypass, the leads were cut in the superior vena cava, and the distal portion was explanted. The device pocket and proximal lead segments were explanted at the end after closure of the sternotomy.…”

2015 ESC Guidelines for the management of infective endocarditis

“…Biorąc pod uwagę nieodłączne ryzyko związane z otwartą operacją kardiochirurgiczną [380], preferuje się przezżylne usunięcie elektrod. Zasadniczą rolę w zapobieganiu nawrotom choroby odgrywa usunięcie układu w całości [368,397]. W doświadczonych ośrodkach odsetek śmiertelności okołozabiegowej wynosi 0,1-0,6% [396,398].…”

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

“…Partial procedures such as generator removal and capping of leads are associated with an almost invariable relapse 10,33,60,61 regardless of clinical presentation. General consensus favours percutaneous removal in centres with procedural volume sufficient to maintain operator skills, and with immediate surgical backup.…”