Abstract 2491: Same-Day Device Reimplantation Following Cardiovascular Implantable Electronic Device Extraction for Isolated Pocket Infection
Objective: Limited published data show outcomes in patients with cardiovascular implantable electronic device (CIED) reimplantation on the same day that a CIED is removed due to isolated pocket infection.
Methods: A retrospective, cohort study was performed in consecutive patients undergoing CIED extraction for infection from 1999–2008. We analyzed the cohort for patient and infection characteristics as well as for procedure indications, details, and outcomes.
Results: Forty-nine patients [mean age 70.6 years; 44 (88%) male] of 138 (36%) infection extractions underwent same-day CIED reimplantation following successful complete extraction for an isolated pocket infection. These patients had pocket swelling, fistula, and/or erosion; blood cultures grew no organisms and no vegetations were seen with TEE. Thirty-six patients (76%) were pacemaker-dependent and 7 (14%) had CRT devices. The mean time from the most recent CIED procedure to infection was 13.8 months (range 0–62). In 35 patients (71%), the most recent CIED procedure was a generator change or device upgrade. Thirty patients had a pacemaker removed and 19 had a transvenous defibrillator removed. After complete extraction of hardware, the infected pocket was completely excised followed by primary wound closure. Same-day implant categories included
replacement CIED already implanted before the extraction (3 patients);
same-day epicardial systems (2); and
same-day, transvenous CIED devices placed in the contralateral subclavicular area (44).
Cultures revealed coagulase negative staphylococcus in 30 patients; S. Aureus in 10; polymicrobial infection in 5; P. Aeruginosa in 2; E. Faecium in 1; and no organism in 1. All patients were treated with oral antibiotic therapy at the time of hospital discharge for 2–4 weeks. The mean post-reimplant follow-up time was 7±18 months. No same-day reimplant patient experienced device re-infection.
Conclusions: Same-day reimplantation is a viable management strategy in selected patients with isolated pocket infection, especially in those with successful complete hardware extraction and pocket removal. This strategy may be particularly useful in those with pacemaker-dependence. Type of microorganism did not affect the rate of re-infection.