Huang Xin-Miao, Fu Hai-Xia, Zhong Li, Cao Jiang, Asirvatham Samuel J, Baddour Larry M, Sohail M Rizwan, Nkomo Vuyisile T, Nishimura Rick A, Greason Kevin L, Suri Rakesh M, Friedman Paul A, Cha Yong-Mei
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.).
Circ Arrhythm Electrophysiol. 2016 Sep;9(9). doi: 10.1161/CIRCEP.116.004188.
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.
在患有心血管植入式电子设备（CIED）和人工瓣膜的患者中，铅相关或瓣膜相关的心内膜炎会使CIED感染复杂化。本研究的目的是确定人工瓣膜患者因CIED感染进行经静脉导线拔除术的结果。
我们回顾性筛选了2001年9月1日至2012年8月31日在梅奥诊所进行的794例经静脉导线拔除术，以确定因感染接受导线拔除术的人工瓣膜患者。分析了人口统计学、临床和随访特征。共有51例患者（6%）符合研究纳入标准，其中20例有囊袋感染，31例有铅相关或瓣膜相关的心内膜炎或血流感染，或两者皆有（平均年龄67[18]岁）。葡萄球菌是最常见的病原体，包括20例（39%）金黄色葡萄球菌和19例（37%）凝固酶阴性葡萄球菌。总体而言，共拔除127根经静脉导线（导线中位使用年限为52个月）。其中123根（97%）被完全拔除。住院死亡率为9.8%；无死亡归因于拔除手术。存活的患者中，95%没有与设备相关或瓣膜相关的复发性感染迹象。
对于患有CIED感染和人工瓣膜的患者，经静脉导线拔除术似乎是安全且有效的。大多数患者通过完全移除CIED并进行抗菌治疗，无需进行瓣膜手术即可治愈感染。
