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Döring M, Müssigbrodt A, Ebert M, Bode K, Lucas J, Dagres N, Hindricks G, Richter S. Transvenous revision of leads with cardiac perforation following device implantation-Safety, outcome, and complications. Pacing Clin Electrophysiol 2020; 43:1325-1332. [PMID: 32909622 DOI: 10.1111/pace.14056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac perforation is a rare complication of cardiac implantable electronic device (CIED) implantation. Transvenous revision of perforated leads is associated with the risk of cardiac tamponade and death. Little is known about periprocedural complications and outcome of these patients. METHODS AND RESULTS All patients referred to our department with evidence or suspicion of cardiac perforation following CIED implantation underwent chest X-ray, transthoracic echocardiography, device interrogation, and, if necessary, a cardiac computed tomography (CT)-scan to diagnose lead perforation and associated complications. Transvenous lead revision (TLR) was performed in all patients with evidence of lead perforation. Patient characteristics, procedural complications, and outcome were recorded and analyzed. Fifty-six patients (75 ± 10 years, 43% male) were diagnosed with cardiac perforation, 34 patients (61%) early within 30 days post-implantation, and 22 patients (39%) thereafter. The most frequent perforation site was the right ventricular (RV) apex (75%), followed by the RV free wall (16%) and the right atrial appendage (9%). A total of 16 patients (29%) presented with severe complications; 12 patients (21%) with pericardial effusion treated by pericardiocentesis before lead revision and four patients (7%) with hematothorax requiring drainage. Late perforations showed significantly more frequent cardiac tamponades (P = .041). TLR was performed without further complications in 54 patients (96%). None of the patients required surgical treatment or experienced in-hospital death. CONCLUSIONS Cardiac perforation following CIED implantation is associated with severe complications in nearly one-third of the cases. Transvenous revision of the perforated lead can safely be performed with a very low complication rate.
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Affiliation(s)
- Michael Döring
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Müssigbrodt
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Micaela Ebert
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Kerstin Bode
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
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Starck CT, Eulert-Grehn J, Kukucka M, Eggert-Doktor D, Dreizler T, Haupt B, Falk V. Managing large lead vegetations in transvenous lead extractions using a percutaneous aspiration technique. Expert Rev Med Devices 2018; 15:757-761. [PMID: 30247076 DOI: 10.1080/17434440.2018.1525292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment of patients with systemic infections of cardiac implantable electronic devices and large lead vegetations are a clinical challenge. In such situations patients potentially had to undergo open surgical extraction in the past. The objective of this study was to evaluate the results of a concomitant percutaneous, minimal-invasive aspiration procedure with the use of an extracorporeal circulation in transvenous lead extraction procedures in patients with large lead vegetations. RESEARCH DESIGN AND METHODS Prior and during transvenous lead extraction procedures lead vegetations were targeted for removal with a percutaneous aspiration technique based on a veno-venous extracorporeal circulation with an in-line filter. Clinical outcomes of the procedures were retrospectively analyzed. RESULTS This innovative and minimal-invasive treatment concept was used in 35 patients with systemic CIED infections (mean echocardiographic lead vegetation size 22.6 (12-40) mm). Complete procedural success of the aspiration procedure was seen in 88.6% of the patients. No major complication related to the aspiration procedure occurred. Clinical success of the concomitant transvenous lead extraction procedures (35 patients, 83 leads) was 97.1%. CONCLUSION The presented data show that the aspiration procedure is safe and efficient as an adjunct in transvenous lead extraction procedures avoiding the need for open surgical extraction in such cases.
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Affiliation(s)
- Christoph T Starck
- a Department of Cardiothoracic & Vascular Surgery , German Heart Center Berlin , Berlin , Germany.,b DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin , Germany.,c Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion , Berlin , Germany
| | - Jürgen Eulert-Grehn
- a Department of Cardiothoracic & Vascular Surgery , German Heart Center Berlin , Berlin , Germany.,b DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin , Germany
| | - Marian Kukucka
- d German Heart Center Berlin , Institute for Anesthesiology , Berlin , Germany
| | - Dirk Eggert-Doktor
- d German Heart Center Berlin , Institute for Anesthesiology , Berlin , Germany
| | - Thomas Dreizler
- e German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery , Team of Cardiovascular Perfusion , Berlin , Germany
| | - Benjamin Haupt
- e German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery , Team of Cardiovascular Perfusion , Berlin , Germany
| | - Volkmar Falk
- a Department of Cardiothoracic & Vascular Surgery , German Heart Center Berlin , Berlin , Germany.,b DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin , Germany.,f Clinic of Cardiac Surgery , University Hospital Charité Berlin , Berlin , Germany
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Koutentakis M, Siminelakis S, Korantzopoulos P, Petrou A, Petrou A, Priavali H, Priavali E, Mpakas A, Gesouli H, Gesouli E, Apostolakis E, Apostolakis E, Tsakiridis K, Zarogoulidis P, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Zarogoulidis K. Surgical management of cardiac implantable electronic device infections. J Thorac Dis 2014; 6 Suppl 1:S173-9. [PMID: 24672692 DOI: 10.3978/j.issn.2072-1439.2013.10.23] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The infection of cardiac implantable electronic devices (CIED) is a serious and potentially lethal complication. The population at risk is growing, as the device implantation is increasing especially in older patients with associated comorbid conditions. Our purpose was to present the management of this complicated surgical condition and to extract the relevant conclusions. METHODS During a 3-year period 1,508 CIED were implanted in our hospital. We treated six cases of permanent pacemaker infection with localized pocket infection or endocarditis. In accordance to the recent AHA/ACC guidelines, complete device removal was decided in all cases. The devices were removed under general anaesthesia, with a midline sternotomy, under extracorporeal circulation on the beating heart. Epicardial permanent pacing electrodes were placed on the right atrium and ventricle before the end of the procedure. RESULTS The postoperative course of all patients was uncomplicated and after a follow up period of five years no relapse of infection occurred. CONCLUSIONS Management protocols that include complete device removal are the only effective measure for the eradication of CIED infections. Although newer technologies have emerged and specialized techniques of percutaneous device removal have been developed, the surgical alternative to these methods can be a safe solution in cases of infected devices.
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Affiliation(s)
- Michael Koutentakis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Stavros Siminelakis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Panagiotis Korantzopoulos
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Anastasios Petrou
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Helen Priavali
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Andreas Mpakas
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Helen Gesouli
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Efstratios Apostolakis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
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