Related Experiment Videos
[Removal of infected pacemaker lead through sternotomy without cardiopulmonary bypass]
Y Matsumoto1, K Akemoto, T Ushijima
1Department of Cardiovascular Surgery, Kanazawa National Hospital, Japan.
Abstract:
A 66-year-old man, who had undergone DDD pacemaker implantation for complete A-V block two years ago, was admitted because of endocarditis with septicemia and renal failure. His blood culture revealed Staphylococcus aureus. We tried to remove the infected cardiac pacemaker lead. But we failed to remove the atrial lead because it was strongly adhered with the right atrial appendage. Antibiotic therapy was ineffective. In the last resort, we operated through median sternotomy three months after the initial infectious episode. In intraoperative inspection, we found it difficult to remove the lead by traction because of atrial residual lead sticking out of the right atrial appendage. We applied a purse string suture on the right appendage and obtained successful removal of infected lead without the cardiopulmonary bypass. His postoperative course has been uneventful. He is totally asymptomatic and doing well up to now. In case of such local infection, we conclude that all transvenous leads should be removed and recommend a simultaneous implantation of the epicardial pacemaker system.
Insights
This study details the successful removal of an infected pacemaker lead using a purse string suture technique, avoiding cardiopulmonary bypass. It recommends removing all transvenous leads for localized infections and switching to epicardial systems.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Pacemaker implantation for complete atrioventricular block carries risks, including late infectious complications.
- Endocarditis and septicemia in pacemaker recipients pose significant management challenges.
Observation:
- A 66-year-old man with a DDD pacemaker presented with Staphylococcus aureus endocarditis, septicemia, and renal failure.
- Initial attempts to remove the infected transvenous lead were unsuccessful due to strong adherence to the right atrial appendage.
- Antibiotic therapy proved ineffective against the persistent infection.
Findings:
- A novel surgical approach involving median sternotomy and a purse string suture on the right atrial appendage enabled successful infected lead removal.
- The procedure was performed without cardiopulmonary bypass, minimizing procedural risks.
- The patient experienced an uneventful postoperative recovery and remained asymptomatic.
Implications:
- This case highlights a viable surgical strategy for managing difficult-to-remove infected pacemaker leads in localized endocarditis.
- For localized pacemaker lead infections, complete transvenous lead extraction is recommended.
- Simultaneous implantation of an epicardial pacemaker system is advised following infected lead removal to prevent recurrence.