title: Outcomes of Transvenous Lead Extraction for Cardiovascular Implantable Electronic Device Infections in Patients With Prosthetic Heart Valves.
abstract: Lead-related or valve-related endocarditis can complicate cardiovascular implantable electronic device (CIED) infection in patients with both CIED and prosthetic valves. The objective of this study was to determine the outcomes of transvenous lead extraction for CIED infection in patients with prosthetic valves.
  
  
  
  We retrospectively screened 794 transvenous lead extraction procedures, between September 1, 2001 and August 31, 2012, at Mayo Clinic to identify patients with prosthetic valves who underwent lead extraction for infection. Demographic, clinical, and follow-up characteristics were analyzed. In total, 51 patients (6%) met the study inclusion criteria, of whom 20 had pocket infection and 31 had lead-related or valve-related, or both, endocarditis or bloodstream infection (mean age, 67 [18] years). Staphylococcal species were the most common pathogens, including Staphylococcus aureus in 20 cases (39%) and coagulase-negative staphylococci in 19 cases (37%). Overall, 127 transvenous leads (median lead age, 52 months) were extracted. Of these leads, 123 (97%) were removed completely. The in-hospital mortality rate was 9.8%; no deaths were attributable to the extraction procedure. Ninety-five percent of patients who survived had no evidence of recurrent device-related or valve-related infection.
  
  
  
  Transvenous lead extraction seems safe and curative in patients with CIED infection and prosthetic valves. Cure of infection can be achieved in the majority of patients with complete CIED removal and antimicrobial therapy and without valve surgery.
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Xin-Miao
authors.initials: XM
authors.lastname: Huang
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Fu
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Li
authors.initials: L
authors.lastname: Zhong
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.). ycha@mayo.edu cecil2060@163.com.
authors.forename: Jiang
authors.initials: J
authors.lastname: Cao
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: M Rizwan
authors.initials: MR
authors.lastname: Sohail
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Vuyisile T
authors.initials: VT
authors.lastname: Nkomo
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: From the Department of Cardiovascular Diseases (X.-m.H., H.-x.F., L.Z., S.J.A., L.M.B., M.R.S., V.T.N., R.A.N., P.A.F., Y.-M.C.), Department of Infectious Diseases (L.M.B., M.R.S.), and Department of Cardiovascular Surgery (K.L.G., R.M.S.), Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, China (X.-m.H., J.C.); Department of Cardiovascular Diseases, Henan Provincial People's Hospital, China (H.-x.F.); and Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China (L.Z.). ycha@mayo.edu cecil2060@163.com.
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology / Q000628:therapy*; D015897:Comorbidity; D020878:Device Removal; D004696:Endocarditis / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: Staphylococcal infections; anti-infective agents; cardiovascular infections; endocarditis; retrospective studies