Transvenous extraction of pacemaker leads in infective endocarditis with vegetations ≥20 mm: our experience.
BACKGROUND
According to published evidence, treatment of infective endocarditis (IE) associated with cardiovascular implantable electronic devices (CIEDs) should include complete removal of the system. Several publications have shown that transvenous removal is an effective and safe nonthoracotomy approach in patients with large vegetations, but experiences with vegetations larger than 20 mm have rarely been reported.


OBJECTIVE
Our aim was to describe our experience in percutaneous removal of CIEDs in patients with IE with large vegetations.


METHODS
The data were collected retrospectively and analyzed prospectively. We evaluated in-hospital morbidity and mortality related to percutaneous removal of vegetations ≥20 mm. This included 8 cases with a follow-up period of 20 months. We removed 100% of leads in the study population.


RESULTS
Two patients experienced minor complications. No patient experienced subclavian vein laceration, hemothorax and lead fracture, or severe tricuspid regurgitation. After the removal procedure, 2 patients had symptoms compatible with pulmonary embolism. Both in-hospital mortality and mortality at follow-up were zero.


CONCLUSIONS
Transvenous extraction of pacing leads with larger vegetations is a feasible technique. There was a tendency toward symptomatic pulmonary embolism in patients with vegetations larger than 20 mm; however, morbidity and mortality were not influenced. We agree with the consensus that this procedure is highly useful and that the selection of the removal techniques will depend not only on the size of vegetation but also on prior cardiopulmonary conditions, concomitant cardiac surgery, atrial septal defect with risk of paradoxical embolism, center experience, and the possibility of complete removal of the device.
Department of Cardiology and Cardiovascular Surgery, University Hospital, Universidad Abierta Interamericana, Faculty of Medicine, Buenos Aires, Argentina. gpbaztarrica@yahoo.com
Gabriel
G
Pérez Baztarrica
Luis
L
Gariglio
Flavio
F
Salvaggio
Estela
E
Reolón
Norberto
N
Blanco
Hector
H
Mazzetti
Sebastián
S
Villecco
Alejandro
A
Botbol
Rafael
R
Porcile
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004566:Electrodes / Q000009:adverse effects*; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013223:Statistics as Topic