title: Transvenous pacemaker lead removal is safe and effective even in large vegetations: an analysis of 53 cases of pacemaker lead endocarditis.
abstract: BACKGROUND
  The aim of this study was to investigate whether transvenous lead removal is safe and effective in patients with lead vegetations greater than 1 cm in size.
  
  
  METHODS
  From 1991 to 2005, a total of 53 patients underwent pacemaker or ICD lead removal for vegetations. Transvenous lead removal using locking stylets and sheaths was performed in 30 patients (56.6%) and was found to be effective in 29 of those patients. In 1 patient, due to rupture of the lead, open heart removal of the ventricular lead remnant and tricuspid valve repair had to be performed due to persistent infection. In 23 of these patients, transesophageal echocardiography (TEE) verified vegetations greater than 1 cm in size. The remaining patients underwent primary lead removal using sternotomy and extracorporeal circulation (ECC). Pacemaker pocket infection was found in 16 patients (55.2%) of the transvenous study group and in 11 patients (45.8%) of the ECC group (P = 0.72).
  
  
  RESULTS
  Perioperative mortality was 5.7% (3 patients); all of them underwent primary ECC removal and had severe endocarditis of the tricuspid valve. None of the patients who underwent transvenous lead removal died and there were no further complications such as pericardial tamponade or major pulmonary embolism requiring further interventions, even in patients demonstrating large vegetations.
  
  
  CONCLUSIONS
  This study demonstrates that transvenous lead removal is a safe and highly effective procedure for the removal of infected pacemaker and ICD leads, even in patients with large vegetations. Embolism to the lung proceeds mainly without further complications; however, patients with vegetations that might obstruct a main stem of the pulmonary artery should undergo ECC removal.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6060 Innsbruck, Austria.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Hangler
authors.forename: Juliane
authors.initials: J
authors.lastname: Kilo
authors.forename: Daniel
authors.initials: D
authors.lastname: Höfer
authors.forename: Ludwig C
authors.initials: LC
authors.lastname: Müller
authors.forename: Florian
authors.initials: F
authors.lastname: Hintringer
authors.forename: Silvana
authors.initials: S
authors.lastname: Müller
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
authors.forename: Herwig
authors.initials: H
authors.lastname: Antretter
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D020878:Device Removal / Q000379:methods / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004696:Endocarditis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index