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Salvage of Infected Cardiac Implantable Electronic Device and Pregnancy Preservation Using CITA-MIS
Moris Topaz1, Anna Mazo1, Ofer Havakuk1
1Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
JACC. Case Reports
|August 29, 2025
Summary
Managing cardiac implantable electronic device (CIED) pocket infections in early pregnancy can be safely achieved with a conservative approach. This method uses targeted antibiotics and minimally invasive surgery, avoiding risky CIED extraction and protecting both mother and fetus.
Area of Science:
- Cardiology
- Infectious Diseases
- Maternal-Fetal Medicine
Background:
- Managing cardiac implantable electronic device (CIED) pocket infections during early pregnancy poses challenges due to current guidelines mandating system extraction.
- Extraction risks include surgical complications, radiation exposure, and teratogenic effects of systemic antibiotics, posing significant maternal-fetal risks.
Observation:
- A 29-year-old pregnant patient (5 weeks) presented with a CIED pocket infection.
- A conservative salvage approach with in situ-targeted ultrahigh-concentration antibiotics and minimally invasive surgery was employed to preserve the pregnancy.
Findings:
- The procedure involved limited surgery, targeted antibiotics, and fetal shielding, maintaining a vancomycin AUC/MIC ratio of 31.7.
- The patient achieved infection resolution and delivered a healthy baby via cesarean section.
Implications:
- This case demonstrates a safe alternative to CIED extraction in pregnant patients, minimizing maternal and fetal harm.
- Expanded guidelines are needed to include conservative salvage strategies for managing CIED infections in high-risk pregnancies.
