Black-Maier Eric, Piccini Jonathan P, Bishawi Muath, Pokorney Sean D, Bryner Benjamin, Schroder Jacob N, Fowler Vance G, Katz Jason N, Haney John C, Milano Carmelo A, Nicoara Alina, Hegland Donald D, Daubert James P, Lewis Robert K
Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA.
Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
JACC Clin Electrophysiol. 2020 Jun;6(6):672-680. doi: 10.1016/j.jacep.2020.02.006. Epub 2020 Apr 29.
The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD).
The use of transvenous lead extraction for the management CIED infection in patients with a durable LVAD has not been well described.
Clinical and outcomes data were collected retrospectively among patients who underwent lead extraction for CIED infection after LVAD implantation at Duke University Hospital.
Overall, 27 patients (n = 6 HVAD; n = 15 HeartMate II; n = 6 Heartmate III) underwent lead extraction for infection. Median (interquartile range) time from LVAD implantation to infection was 6.1 (2.5 to 14.9) months. Indications included endocarditis (n = 16), bacteremia (n = 9), and pocket infection (n = 2). Common pathogens were Staphylococcus aureus (n = 10), coagulase-negative staphylococci (n = 7), and Enterococcus faecalis (n = 3). Sixty-eight leads were removed, with a median lead implant time of 5.7 (3.6 to 9.2) years. Laser sheaths were used in all procedures, with a median laser time of 35.0 s (17.5 to 85.5s). Mechanical cutting tools were required in 11 (40.7%) and femoral snaring in 4 (14.8%). Complete procedural success was achieved in 25 (93.6%) patients and clinical success in 27 (100%). No procedural failures or major adverse events occurred. Twenty-one patients (77.8%) were alive without persistent endovascular infection 1 year after lead extraction. Most were treated with oral suppressive antibiotics after extraction (n = 23 [82.5%]). Persistent infection after extraction occurred in 4 patients and was associated with 50% 1-year mortality.
Transvenous lead extraction for LVAD-associated CIED infection can be performed safely with low rates of persistent infection and 1-year mortality.
本研究的目的是评估经静脉导线拔除术在左心室辅助装置（LVAD）患者心血管植入式电子设备（CIED）感染中的应用价值。
对于使用耐用LVAD的患者，经静脉导线拔除术用于管理CIED感染的情况尚未得到充分描述。
回顾性收集在杜克大学医院接受LVAD植入术后因CIED感染而进行导线拔除术的患者的临床和结局数据。
总体而言，27例患者（n = 6例HeartWare心室辅助装置；n = 15例HeartMate II；n = 6例Heartmate III）因感染接受了导线拔除术。从LVAD植入到感染的中位（四分位间距）时间为6.1（2.
