title: Surgical management of infected cardiac implantable electronic devices.
abstract: The growing use of cardiac implantable electronic devices (CIED) has led to infections requiring intervention. These are traditionally managed using a percutaneous transvenous approach to fully extract the culpable leads. Indications for such strategies are well-established and range from simple traction to the use of powered extraction tools including laser sheaths. Where such attempts fail, or if there are further complications, then there may be need for a cardiothoracic surgical approach. Limited evidence is currently available on the merits of individual strategies, and these are mainly drawn from case reports or series. Most utilise cardiopulmonary bypass, cardioplegic arrest and entry within the right atrium to allow direct visualisation of any vegetation and safely explant all CIED components whilst avoiding perforation, valvular and paravalvular damage. In this review, we describe a number of these and the unique challenges faced by surgeons when attempting to extract CIED. It is clear that future work should concentrate on creating clear consensus and guidelines on indications, risks and measures of efficacy outcomes for various surgical techniques.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom. Electronic address: umar.chaudhry07@imperial.ac.uk.
authors.forename: Umar A R
authors.initials: UA
authors.lastname: Chaudhry
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom. Electronic address: leanne.harling@imperial.ac.uk.
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom. Electronic address: h.ashrafian@imperial.ac.uk.
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom. Electronic address: tathan5253@aol.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Athanasiou
authors.affiliation: Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece. Electronic address: tsipasp@yahoo.gr.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Tsipas
authors.affiliation: Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece. Electronic address: kokotsakis@internet.gr.
authors.forename: John
authors.initials: J
authors.lastname: Kokotsakis
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom. Electronic address: t.athanasiou@imperial.ac.uk.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D001145:Arrhythmias, Cardiac / Q000628:therapy*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects* / Q000382:microbiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D014943:Global Health; D015994:Incidence; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery*
keywords: Cardiac implantable electronic devices; Cardiopulmonary bypass; Circulatory arrest; Transvenous lead extraction