Bisignani Antonio, De Bonis Silvana, Mancuso Luigi, Ceravolo Gianluca, Bisignani Giovanni
Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy.
Department of Cardiology, Ospedale "Ferrari", Castrovillari, Cosenza, Italy.
Pacing Clin Electrophysiol. 2019 Oct;42(10):1340-1346. doi: 10.1111/pace.13787. Epub 2019 Sep 3.
The gold standard to treat cardiovascular implantable electronic devices (CIEDs) infections is the complete system removal. The aim of this retrospective analysis is to assess the feasibility and safety of an alternative conservative surgical system revision approach, to be applied in elderly patients who refused the extraction procedure, in case of no signs of systemic infection.
Between May 2009 and January 2019, we performed system revision of 25 patients (15 men and 10 women, median age 81 [IQ: 75-85] years) with negative blood culture, no signs of vegetation, who experienced CIED infections.
In all patients the following surgical procedure was applied: the pocket was opened, the wound's necrotic tissue was dissected en bloc; fibrotic tissue was excised. The pocket was washed with hydrogen peroxide and saline solution. The pocket was then closed without implanting the device and left with a continuous infusion of antibiotics and normal saline for 4 days. Subsequently the new generator was implanted, possibly in a different pocket than the previous one. All patients underwent a median follow up of 24 [IQ: 14-34] months. In 24 patients out of the 25 observed the procedure was safe and effective, except for one patient who needed the extraction.
The two-stage surgical revision technique is feasible and safe. It may be considered for elderly patients who refused extraction and presented no signs of systemic infection or in some categories of patients. In case of failure of the procedure, subsequent treatment with complete extraction of the system would not be precluded.
治疗心血管植入式电子设备（CIEDs）感染的金标准是完全移除系统。本回顾性分析的目的是评估一种替代性保守手术系统修复方法的可行性和安全性，该方法适用于拒绝拔除手术且无全身感染迹象的老年患者。
2009年5月至2019年1月期间，我们对25例CIED感染患者（15例男性和10例女性，中位年龄81岁[智商：75 - 85岁]）进行了系统修复，这些患者血培养阴性，无赘生物迹象。
所有患者均采用以下手术步骤：打开囊袋，整块切除伤口的坏死组织；切除纤维化组织。用过氧化氢和生理盐水冲洗囊袋。然后不植入设备关闭囊袋，并持续输注抗生素和生理盐水4天。随后植入新的发生器，可能植入与先前不同的囊袋中。所有患者的中位随访时间为24个月[智商：14 - 34个月]。在观察的25例患者中，除1例需要拔除的患者外，24例患者的手术安全有效。
两阶段手术修复技术可行且安全。对于拒绝拔除且无全身感染迹象的老年患者或某些类型的患者可考虑采用。若手术失败，不排除随后进行系统完全拔除的治疗。
