title: Same-day contralateral implantation of a permanent device after lead extraction for isolated pocket infection.
abstract: OBJECTIVE
  The purpose of this study is to examine the safety and outcomes of same-day reimplantation at the contralateral pectoral site in patients with device extraction for pocket infection but with negative blood cultures and no signs of systemic infection.
  
  
  RESULTS
  Clinical and procedure-related data were retrospectively collected on 15 (11 male, mean age 77) device-dependent patients who underwent device and complete lead extraction (mean 2.5 leads per patient, mean implant duration 6.2 years) for local pocket infection, and who had a new contralateral device implanted on the same day. Temporary pacing via the femoral vein was used during extraction. The infected pocket was managed with an elliptical skin incision, debridement, full capsule resection, and primary wound closure with the end of the wound left open for a Penrose drain. Intravenous antibiotics were used prior to and through the procedure, and continued for a mean of 2 days post-procedure, with oral antibiotics used thereafter for a mean course of 2 weeks. No infections of the new device system occurred, with a mean follow-up of 39.6 months (range 12-74 months).
  
  
  CONCLUSIONS
  In the setting of device erosion and isolated pocket infection without systemic or bloodstream involvement, a new contralateral device may be implanted on the same day as pocket debridement and system extraction without developing infection of the new permanent hardware. This strategy can be useful in patients with pacemaker-dependence, as an alternative to using a temporary pacing system.
authors.affiliation: Cardiovascular Division, North Shore University Hospital, Hofstra School of Medicine, 300 Community drive, Manhasset, NY 11030, USA.
authors.forename: Stavros E
authors.initials: SE
authors.lastname: Mountantonakis
authors.forename: Cory M
authors.initials: CM
authors.lastname: Tschabrunn
authors.forename: Marc W
authors.initials: MW
authors.lastname: Deyell
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D003646:Debridement; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Device infection; Device-related complications; Endocarditis; Lead extraction