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Rivista sulle Malattie del Cuore e dei Vasi
Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Cardioangiologica 2015 April;63(2):91-8
Coronary sinus lead extraction in CRT patients with CIED-related infection: risks, implications and outcomes
Lisy M. 1, Schmid E. 2, Kalender G. 1, Stock U. A. 3, Doernberger V. 4, Khalil M. 3, Kornberger A. 3 ✉
1 Department of General, Visceral, Thoracic and Vascular Surgery, Frankfurt‑Höchst City Hospital, Frankfurt, Germany;
2 Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany;
3 Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany;
4 Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
AIM: The aim of the study was to examine risks, implications and outcomes of coronary sinus (CS) lead extraction in patients with infections of cardiac resynchronization therapy (CRT) systems.
METHODS: The study included 40 (65.5±11.1 years; 80% male) transvenous CS lead extraction procedures performed between 2000-2011. Nine (22.5%) patients suffered from infection and included one sepsis (11.1%), two (22.2%) of lead and valve endocarditis, and four (44.4%) cases of pocket infection. CS lead extraction in the infection subgroup was performed between 14 days and more than five years after the last CIED-related surgical procedure.
RESULTS: Totally 42 CS and 35 non-CS leads were extracted. Leads extracted in the infection subgroup were significantly longer in situ (49.7±30.7 months) compared to the non-infection subgroup (19.2±28.6 months). Extraction in infected patients required more aggressive methods and longer exposure to radiation than non-infected. Procedural success without major complications was achieved in all patients. Minor post-procedural complications occurred in four (44.4%) of the infected and one (3.2%) of the non-infected patients and were surgical-related in three cases. Overall hospitalization times were significantly longer for the infection than for the non-infection subgroup (21.4±15 versus 9.6±6.9 days).
CONCLUSION: Our results support the concept of complete CIED-system removal in CIED-associated infection, regardless of whether or not infection appears to be limited to the generator pocket site, despite risk of heart failure, patient frailty and a high level of comorbidity. An interdisciplinary approach encompassing appropriate diagnostic, procedural and safety standards allows CS lead extraction in this high-risk subpopulation to be performed with excellent outcomes and low complication rates.