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Parlavecchio A, Vetta G, Caminiti R, Magnocavallo M, Ajello M, Dattilo G, Foti R, Di Bella G, Al-Maisary SSA, Coluccia G, Palmisano P, Della Rocca DG, Crea P. Endocardial versus epicardial pacing in pacemaker-dependent patients after device extraction: a meta-analysis. Expert Rev Med Devices 2023:1-7. [PMID: 37306604 DOI: 10.1080/17434440.2023.2223968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Pacemaker-dependent (PM) patients with cardiac implantable electronic device (CIED) infection require implantation of a temporary-pacemaker (TP) and delayed endocardial reimplantation or implantation of an epicardial-pacing-system (EPI) before device extraction. Our aim was to compare the TP and EPI-strategy after CIED extraction through a meta-analysis. METHODS We searched electronic databases up to 25 March 2022, for observational studies that reported clinical outcomes of PM-dependent patients implanted with TP or EPI-strategy after device extraction. RESULTS 3 studies were included enrolling 339 patients (TP: 156 patients; EPI: 183 patients). TP compared to EPI showed reduction in the composite outcome of relevant complications (all-cause death, infections, need for revision or upgrading of the reimplanted CIED) (12.1% vs 28.9%; RR: 0.45; 95%CI: 0.25-0.81; p = 0.008) and a trend in reduction of all-cause death (8.9% vs 14.2%; RR: 0.58; 95%CI: 0.33-1.05; p = 0.07). Furthermore, TP-strategy proved to reduce need of upgrading (0% vs 12%; RR: 0.07; 95%CI: 0.01-0.52; p = 0.009), reintervention on reimplanted CIED (1.9% vs 14.7%; RR: 0.15; 95%CI: 0.05-0.48; p = 0.001) and significant increase in pacing threshold (0% vs 5.4%; RR: 0.17; 95%CI: 0.03-0.92; p = 0.04), with a longer discharge time (MD: 9.60 days; 95%CI: 1.98-17.22; p = 0.01). CONCLUSION TP-strategy led to a reduction of the composite outcome of all-cause death and complications, upgrading, reintervention on reimplanted CIED, and risk of increase in pacing threshold compared to EPI-strategy, with longer discharge time.
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Affiliation(s)
- Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, Rome, Italy
| | - Manuela Ajello
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosario Foti
- Cardiology Unit, San Vincenzo Hospital, Taormina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | | | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Kremer J, Al-Maisary SSA, Szabó G. A Clean Cut: Minimally Invasive Mitral Valve Replacement after Heart Transplantation. Thorac Cardiovasc Surg Rep 2019; 8:e27-e29. [PMID: 31440439 PMCID: PMC6703990 DOI: 10.1055/s-0039-1693451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/30/2019] [Indexed: 11/15/2022] Open
Abstract
A 50-year-old female presented with progressive heart failure due to obstruction of the mitral valve after heart transplantation in 2008. Through the occlusion catheter (IntraClude Intra-Aortic Occlusion Device), aortic cross-clamping, antegrade cardioplegia, and aortic root venting were performed. Our case reports the first published study on minimally invasive mitral valve replacement for valve stenosis through intraluminal aortic clamping. The hazard of traumatic injuries can be reduced by avoiding resternotomy and circumventing adhesions between the aorta and the pulmonary artery after heart transplantation. Minimally invasive valve surgery is a safe and effective method with regard to short- and long-term results, especially in redo operations.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Germany
| | | | - Gábor Szabó
- Department of Cardiac Surgery, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Germany
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Al-Maisary SSA, Romano G, Karck M, De Simone R. Epicardial pacemaker as a bridge for pacemaker-dependent patients undergoing explantation of infected cardiac implantable electronic devices. J Card Surg 2019; 34:424-427. [PMID: 31017328 DOI: 10.1111/jocs.14058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/05/2019] [Accepted: 03/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Cardiac implantable electronic device (CIED) implantation is associated with an increase in CIED infection. For pacemaker-dependent patients, temporary pacemaker leads are implanted until infection remission, which allows new CIED implantation. We compared the outcome of pacemaker-dependent patients with infected CIED based on whether a combined single procedure of epicardial pacemaker implantation with system extraction or a temporary transjugular pacemaker implantation with interval system implantation was performed. METHODS This retrospective study included pacemaker-dependent patients with CIED infection who were divided into two groups: the Tempo and Epi groups. The Tempo group received temporary transvenous pacemaker connected to an external pulse generator. After infection remission, a new permanent pacemaker was implanted, and the temporary pacemaker leads were removed. The Epi group received implantable epicardial right-ventricular pacemaker through infrasternal inferior pericardiotomy, and a permanent pulse generator was implanted through the same incision between the subcutaneous tissue and abdominal fascia. RESULTS Sixty-six patients were included. Forty-two patients with epicardial pacemakers were discharged after 9.5 ± 8.8 days without infection of the newly implanted epicardial pacemaker. Patients with temporary transjugular pacemaker lead were discharged 23 ± 15 days after receiving permanent pacemakers. No serious complications were recorded in the Epi group. CONCLUSIONS CIED infections in pacemaker-dependent patients can be treated through epicardial pacemaker implantation that allows early patient mobility and reduces hospital stay with no risk of epicardial pacemaker infection. Epicardial pacemakers can be used as a bridge until permanent intravenous CIED is implanted or as a replacement for permeant intravenous CIED.
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Affiliation(s)
| | - Gabriele Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
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