Infectious mass debulking in lead-associated endocarditis with a percutaneous aspiration system.

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Innovation

Background:

• Debulking infected material is crucial in managing infections.
• Transvenous lead extraction (TLE) is a procedure for managing cardiac device infections.
• The role of debulking during TLE for bloodstream infection (BSI) requires investigation.

Purpose of the Study:

• To evaluate the effectiveness of percutaneous debulking during TLE in patients with BSI.
• To determine if reducing the infective burden impacts patient survival.

Main Methods:

• An observational, single-center study was conducted from 2015-2022.
• 137 patients undergoing TLE for BSI, with or without vegetations, were analyzed.
• A percutaneous aspiration system was used for debulking.

Main Results:

• Patients with active BSI at intervention showed significantly improved survival with percutaneous aspiration (log-rank: P = 0.0082).
• Patients with suppressed BSI at intervention did not show a significant survival benefit from percutaneous aspiration (log-rank: P = 0.25).

Conclusions:

• Percutaneous debulking of lead vegetations may enhance survival in patients with active BSI undergoing TLE.
• The timing of BSI suppression is critical when considering percutaneous debulking during TLE.