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Surgical management of cardiac implantable electronic device infections
Michael Koutentakis1, Stavros Siminelakis1, Panagiotis Korantzopoulos1
11 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece.
Insights
Complete removal of infected cardiac implantable electronic devices (CIED) is crucial for eradication. Surgical intervention offers a safe and effective solution for managing CIED infections, even with emerging alternative technologies.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Cardiac implantable electronic devices (CIED) infections are a growing concern, particularly in aging populations with comorbidities.
- These infections pose a serious, potentially lethal risk to patients.
Purpose of the Study:
- To present the management strategy for infected CIED.
- To extract conclusions regarding the efficacy of treatment protocols for CIED infections.
Main Methods:
- Six cases of permanent pacemaker infection (pocket infection or endocarditis) were treated.
- Complete device removal was performed under general anesthesia with sternotomy and extracorporeal circulation.
- Epicardial pacing electrodes were implanted in the right atrium and ventricle post-removal.
Main Results:
- All patients experienced an uncomplicated postoperative course.
- No relapse of infection was observed after a five-year follow-up period.
Conclusions:
- Complete CIED removal is essential for eradicating device infections.
- Surgical device removal remains a safe and effective option for managing CIED infections, complementing newer techniques.
Purpose:
The infection of cardiac implantable electronic devices (CIED) is a serious and potentially lethal complication. The population at risk is growing, as the device implantation is increasing especially in older patients with associated comorbid conditions. Our purpose was to present the management of this complicated surgical condition and to extract the relevant conclusions.
Methods:
During a 3-year period 1,508 CIED were implanted in our hospital. We treated six cases of permanent pacemaker infection with localized pocket infection or endocarditis. In accordance to the recent AHA/ACC guidelines, complete device removal was decided in all cases. The devices were removed under general anaesthesia, with a midline sternotomy, under extracorporeal circulation on the beating heart. Epicardial permanent pacing electrodes were placed on the right atrium and ventricle before the end of the procedure.
Results:
The postoperative course of all patients was uncomplicated and after a follow up period of five years no relapse of infection occurred.
Conclusions:
Management protocols that include complete device removal are the only effective measure for the eradication of CIED infections. Although newer technologies have emerged and specialized techniques of percutaneous device removal have been developed, the surgical alternative to these methods can be a safe solution in cases of infected devices.
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