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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(03): 344-349
DOI: 10.1055/s-0041-1735417
Original Article

Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision

Pallab Chatterjee
1   Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
,
Anuj Kumar Sharma
2   Department of Surgery, Army Hospital (R & R) Delhi Cantt, India
,
Pranay Pratap
1   Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
,
Ajay Dabas
3   Department of Surgery, Command Hospital (NC), Udhampur, Jammu and Kashmir, India
,
Bharat Mishra
1   Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
,
Samiksha Mehare
1   Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
› Author Affiliations Funding None.
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Abstract

Introduction Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence.

Aim To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study.

Material and Methods Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension.

Results Twelve patients (m = 10; f = 2) with a mean age of 65 years (range, 46–82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8–30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality.

Conclusion In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.

Keywords

CIED infection - CIED salvage - subpectoral CIED implantation - pectoralis major muscle


Publication History

Article published online:
08 October 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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