Objectives: Predictors of procedural success in transvenous lead extraction (TLE) as well as procedure-related complications have been extensively studied recently. However, despite excellent success rates and rare procedure-related adverse events, the clinical course of patients with endocarditis remains unclear. We performed this retrospective study to evaluate clinical outcomes after TLE in cardiac implantable electronic device (CIED)-related endocarditis.
Methods: All consecutive patients with lead endocarditis (positive blood culture and presence of lead or tricuspid valvular vegetations) who received TLE between August 2011 and December 2017 at our institution were included in this study. Patient data were retrospectively analyzed to observe demographics, complications and to ascertain predictors of mortality.
Results: Fifty-eight patients which fulfilled the inclusion criteria were identified (mean age 70.3 ± 9.9 years, 81% males). Mean hospital stay was 18.7 days ± 15.8. 11 patients (18.9%) had a concomitant pacemaker pocket infection. Most frequently identified bacteria were S. aureus (46%), S. epidermidis (13.7%), and Enterobacter spp. (10.3%). Major adverse events occurred in 11 cases (1 pericardial tamponade, 1 ventricular fibrillation, 9 aggravated sepses). The overall intrahospital mortality was 10.3%. Significant predictors of mortality were higher preoperative CRP (p = 0.026), preoperative sepsis (p < 0.001) and left heart vegetation (p < 0.001). In 16 cases, lead vegetation size exceeded 2 cm, but this did not correlate with occurrence of a major postoperative event.
Conclusions: CIED endocarditis is associated with adverse intrahospital outcome and high mortality despite successful lead and device removal. A high CRP value, preoperative sepsis and the infectious involvement of the left heart correlate with poor postoperative results. Nevertheless, even leads with large vegetations can be treated percutaneously without increasing the procedural risk.
