title: Coronary sinus lead extraction in CRT patients with CIED-related infection: risks, implications and outcomes.
abstract: OBJECTIVE
  The aim of the study was to examine risks, implications and outcomes of coronary sinus (CS) lead extraction in patients with infections of cardiac resynchronization therapy (CRT) systems.
  
  
  METHODS
  The study included 40 (65.5 ± 11.1 years; 80% male) transvenous CS lead extraction procedures performed between 2000-2011. Nine (22.5%) patients suffered from infection and included one sepsis (11.1%), two (22.2%) of lead and valve endocarditis, and four (44.4%) cases of pocket infection. CS lead extraction in the infection subgroup was performed between 14 days and more than five years after the last CIED-related surgical procedure.
  
  
  RESULTS
  Totally 42 CS and 35 non-CS leads were extracted. Leads extracted in the infection subgroup were significantly longer in situ (49.7 ± 30.7 months) compared to the non-infection subgroup (19.2 ± 28.6 months). Extraction in infected patients required more aggressive methods and longer exposure to radiation than non-infected. Procedural success without major complications was achieved in all patients. Minor post-procedural complications occurred in four (44.4%) of the infected and one (3.2%) of the non-infected patients and were surgical-related in three cases. Overall hospitalization times were significantly longer for the infection than for the non-infection subgroup (21.4 ± 15 versus 9.6 ± 6.9 days).
  
  
  CONCLUSIONS
  Our results support the concept of complete CIED-system removal in CIED-associated infection, regardless of whether or not infection appears to be limited to the generator pocket site, despite risk of heart failure, patient frailty and a high level of comorbidity. An interdisciplinary approach encompassing appropriate diagnostic, procedural and safety standards allows CS lead extraction in this high-risk subpopulation to be performed with excellent outcomes and low complication rates.
authors.affiliation: Department of General, Visceral, Thoracic and Vascular Surgery, Frankfurt‑Höchst City Hospital, Frankfurt, Germany - lisy90@googlemail.com.
authors.forename: M
authors.initials: M
authors.lastname: Lisy
authors.forename: E
authors.initials: E
authors.lastname: Schmid
authors.forename: G
authors.initials: G
authors.lastname: Kalender
authors.forename: U A
authors.initials: UA
authors.lastname: Stock
authors.forename: V
authors.initials: V
authors.lastname: Doernberger
authors.forename: M
authors.initials: M
authors.lastname: Khalil
authors.forename: A
authors.initials: A
authors.lastname: Kornberger
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D054326:Coronary Sinus; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004696:Endocarditis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors