Heart Care Info - Heart Disease Prevention & Treatment

... of new minimally invasive pacemaker lead explantation technique with conventional approach via median sternotomy in infective endocarditis in a presence of large ...

SKG Maier, M Rouw, T Zielinski, Y Cho... - ..., 2011 - Eur Heart Rhythm Assoc Abstract Introduction: ICD/CRT devices are in the infant stages of clinical acceptance concerning their ability for fluid monitoring in heart failure (HF) patients. In reality,> 30% of HF patients have a preserved LV-function and no indication for an ICD or CRT-device. We ...

Purpose: Infective endocarditis is one of the most severe complications after pacemaker implantation with mortality up to 33%. In most of the cases infected leads could be removed via transcutaneous non-surgical approaches, e.g. with lead extraction sheaths or laser extraction. In the presence of lead vegetations with size>10mm the potential hazard of pulmonary embolism increases substantially. The frequent concomitant endocarditis of the tricuspid valve makes an open-heart surgery necessary. In our study we evaluated a new minimally invasive lead explantation technique (MI) in comparison with conventional gold standard approach via median sternotomy (SG).

Methods: In 20 patients with infective endocarditis and large lead-vegetations (>10mm) an open-heart surgical lead explantation was performed. In 12 patients leads were removed conventionally via median sternotomy, in 8 patients via video-assisted right mini-thoracotomy (6 cm, 4th intercostal space, video-port in 2nd intercostal space, cardiopulmonary bypass: femoral artery and femoral vein or combination of femoral vein and right jugular vein). In some cases, if necessary,concomitant tricuspid or mitral valve surgery in both groups, or CABG in SG were also performed.

Results: In all cases leads were completely removed. In SG the median age of the patients was 60 years vs. 66 in MI, body-mass-index 25.7 vs. 26.4 kg/m2. In fifty percent of the patients in both groups concomitatnt tricuspid valve repair/replacement, mitral valve repair or CABG were performed. The operation time was 227 vs. 196 min and bypass time 93 vs. 117 min. One patient in SG died postoperatively due so sepsis whereas no deaths in MI were recorded. ICU-stay was 8.9 vs. 2.3 days. In 4 patients (25%) from SG re-thoracotomy due to bleeding was performed, no re-thoracotomy in MI was necessary. SG patients received in median 4.6 blood units in comparison to 2.0 units in MI.

Conclusions: New minimally invasive pacemaker lead explantation technique, even in combination with tricuspid valve repair/replacement or mitral valve repair, seems to be safe and effective. Moreover, if there are no additional reasons for median sternotomy (e.g. concomitant CABG), the minimally invasive approach seems to be superior to conventional median sternotomy in term of pain and bleeding reduction, reduced ICU and hospital stay and improved cosmesis, and might be more than an alternative to conventional procedure.