title: Long-term outcome of complete cardiovascular implantable electronic device removal with cardiopulmonary bypass.
abstract: Definitive endovascular techniques have been developed for pacemaker lead extraction; however, a few patients require immediate secondary open heart surgery because of incomplete transvenous lead extraction. This study examined the safety, effectiveness, and long-term outcome of the removal of cardiovascular implantable electronic device (CIED) via median sternotomy under cardiopulmonary bypass. The removal of CIED was performed in 6 patients (mean age 57 ± 16 years, 5 males and 1 female), from September 2000 to April 2011. The reasons for removal included eradication of an infection in 5 patients and elimination of pacemaker component allergy in 1. Positive culture results, including methicillin-sensitive Staphylococcus aureus (MSSA, n = 2), methicillin-resistant S. aureus (MRSA, n = 1), coagulase-negative staphylococci (CNS, n = 1), and methicillin-resistant S. epidermidis (MRSE, n = 1) were observed in all 5 infected patients. Mitral annuloplasty (n = 1), mitral valvuloplasty (n = 1), tricuspid annuloplasty (n = 3). Implantation of myocardial pacing leads (n = 5) were performed concomitantly (n = 4), or secondarily (n = 1). All 6 patients were alive in good condition at 72 ± 55 months following CIED removal. New device infection occurred in 1 patient during long-term follow up. Complete surgical removal of pacing systems via median sternotomy with cardiopulmonary bypass is, therefore, considered to be safe and feasible with acceptable long term results.
authors: Department of Cardio-thoracic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan. okmasaho123@gmail.com
authors: Masaho
authors: M
authors: Okada
authors: Yuji
authors: Y
authors: Narita
authors: Yoshimori
authors: Y
authors: Araki
authors: Hideki
authors: H
authors: Oshima
authors: Akihiko
authors: A
authors: Usui
authors: Yuichi
authors: Y
authors: Ueda
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000628:therapy; D056346:Sternotomy; D016896:Treatment Outcome