Elsevier

The Annals of Thoracic Surgery

Volume 72, Issue 6, December 2001, Pages 2130-2132
The Annals of Thoracic Surgery

Case report
Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations

https://doi.org/10.1016/S0003-4975(01)02726-6Get rights and content

Abstract

We present the case of a patient with vegetations on a pacing lead from a pacemaker implanted 13 years previously. A new surgical technique for removal of infected leads was developed to avoid the increased risk of septic pulmonary embolism. The electrode with vegetations was removed without cardiopulmonary bypass using the direct surgical approach described.

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Comment

A mortality rate as high as 66% has been reported when infection of a pacemaker system is left completely untreated 3, 4. If managed correctly, most patients with pocket infection do not have development of lead endocarditis. Partial explantation usually result in recurrent infection despite antibiotic therapy [5]. Thus, there is wide agreement that when any part of the system is infected, all pacemaker hardware should be removed.

The most simple method for pacemaker lead extraction is direct,

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Cited by (18)

  • Influence of vegetation shape on outcomes in transvenous lead extractions: Does shape matter?

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    Additionally, Staphylococcus species were present in 34 of the 51 vegetations (67%) in the small vegetation group and 16 of 31 (51%) in the large group (Table 3 and Figure 4). There is agreement with regard to the management of patients with small vegetations; however, there is still controversy regarding the management of large vegetations.13,17,18 In patients with small vegetations <2 cm, TLE is the optimal approach for device removal.2

  • Surgical management of infected cardiac implantable electronic devices

    2016, International Journal of Cardiology
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    There may also be additional instances in which CPB may be required in order to completely remove all CEID components. These may include removing the right atrial appendage [27], conversion to hypothermic circulatory arrest to allow the surgeon to perform venotomies [28], partial clamping of the right atrial appendage and utilising a woven graft to extract the leads using a hook [29] or careful dissection from other structures including the papillary muscles and chordae [30]. Similar techniques utilising an open cardiothoracic surgical approach to treat bacterial infections using CPB have been reported for more than a decade with successful reported outcomes [31–36].

  • Cardiovascular Implantable Electronic Device Associated Infections

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    Thus, device extraction in the setting of gram-negative bacteremia is not recommended without clinical or echocardiographic evidence of CIED infection unless bacteremia is persistent or relapses without another defined focus of infection.62 Historically, surgical lead removal with a thoracotomy was considered in patients with vegetation diameters less than 10 mm or with retained hardware after failed attempts with percutaneous lead removal.58,73–75 The preference for surgical approach among patients with larger vegetations was based in large part on previous investigations of patients with infective endocarditis (valve infections) in which vegetation diameters greater than 10 mm were associated with a significantly higher incidence of embolic events than vegetation diameters less than 10 mm.76

  • Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram

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    Patients with device-related infection and intracardiac vegetations >1 cm have historically undergone surgical thoractomy for device removal because of the potential for septic embolization. Literature supporting this management approach is limited (6,14,28,29). Our single-center experience involving this high-risk population suggests that standard endovascular percutaneous extraction of leads is both feasible and safe.

  • Vegetation Size. Marker for Extraction Technique?

    2010, Journal of the American College of Cardiology
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