Vaidya Gaurang Nandkishor, Deam A Gregory
Department of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA.
J Cardiol Cases. 2018 Apr 26;18(1):17-19. doi: 10.1016/j.jccase.2018.03.006. eCollection 2018 Jul.
The infection rates of implanted cardiac devices have increased disproportionate to the dramatic increase in implantation rates, possibly related to rising patient comorbidities. Optimum strategy in cases with larger size vegetations, however, remains to be ascertained. In the absence of an effective and less invasive alternative, such patients usually undergo open thoracotomy for lead extraction. We describe the case of a 50-year-old female presenting with recurrent methicillin-resistant bacteremia found to have 3 cm highly mobile vegetation on the right ventricular lead of her implanted defibrillator. While being intermediate-to-low surgical risk, she underwent AngioVac-directed suction debulking (AngioDynamics, Latham, NY, USA) of the vegetation simultaneously preceding percutaneous laser lead extraction in a single session. This less invasive alternative to open thoracotomy has been described in high surgical risk patients, but its widespread role remains unexplored. < Complete lead extraction is recommended in all cases of lead infection. However in the presence of large-size lead vegetation, the optimum management strategy is still controversial, especially among high-risk surgical patients. AngioVac system (AngioDynamics, Latham, NY, USA) has a centrifugal suction cannula which can offer a safer and less invasive percutaneous alternative to open thoracotomy approach, with a possibility of large-scale application due to faster recovery.>.
植入式心脏设备的感染率增长与植入率的急剧上升不成比例，这可能与患者合并症增多有关。然而，对于较大尺寸赘生物的病例，最佳策略仍有待确定。在缺乏有效且侵入性较小的替代方法的情况下，此类患者通常需要进行开胸手术以取出导线。我们描述了一例50岁女性病例，该患者反复出现耐甲氧西林菌血症，在其植入式除颤器的右心室导线上发现有一个3厘米的高度活动赘生物。虽然她的手术风险为中低水平，但她在单次经皮激光导线取出术前同时接受了AngioVac引导的赘生物抽吸减容术（AngioDynamics公司，美国纽约州拉瑟姆）。这种侵入性小于开胸手术的替代方法已在高手术风险患者中有所描述，但其广泛应用的作用仍未得到探索。<所有导线感染病例均建议完全取出导线。然而，在存在大尺寸导线赘生物的情况下，最佳管理策略仍存在争议，尤其是在高风险手术患者中。AngioVac系统（AngioDynamics公司，美国纽约州拉瑟姆）有一个离心抽吸套管，它可以提供一种比开胸手术更安全、侵入性更小的经皮替代方法，由于恢复更快，有可能大规模应用。>
