Rational Choice Method of Removal of Endocardial Pacemaker Electrodes in Patients with Infective Endocarditis

Dmitriy D. Zhiltsov ¹, Alexander P. Medvedev ², Mikhail V. Ryazanov ¹, Oleg I. Demarin ¹, Viktor E. Vaykin ¹, Nikolay L. Shibanov ¹, Ivan N. Skvortsov ¹

¹ Specialized Cardiosurgery Clinical Hospital, Nizhniy Novgorod, Russia; ² Nizhny Novgorod State Medical Academy, Nizhniy Novgorod, Russia;

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective:

To develop the algorithm of choosing the optimal method of extraction of endocardial electrodes during open surgery, minimizing the risk of developing life-threatening complications.

Methods:

For the period 1986-2017 operated 46 patients with purulent-septic complications in pacemaker and clinical manifestations of infective endocarditis (0.23% of the total number of implanted stimulation systems in the Nizhny Novgorod region). Of this total, 31 patients (67,4%) were operated in conditions of artificial blood circulation. 15 (32,6%) on a beating heart: 11 via thoracotomy and 4 through a median sternotomy. The maximum number of remooved electrodes was 4.

The indication for surgery in conditions of artificial blood circulation were: electrode-associated infective endocarditiswith destructive changes of the tricuspid valve, abscesses of the right atrium and ventricle, annulus and valve leaflets, the inefficiency of antibiotic therapy, "embolohenic" vegetation (more than 10 mm in diameter, soft vegetation).

Surgery on a beating heart was performed with ineffective removal of the electrodes by direct traction and using endovascular devices.

Results:

In all cases, the endocardial electrodes were removed. Hospital mortality was 0%. During artificial blood circulation reconstructive surgery, TV was performed in 18 (58,1) cases (de VEGA technique), prosthetics TV in 12 (41,9%) cases. Surgery on a beating heart was performed using a purse-string suture and lateral clamping in the region of confluence of the superior Vena cava into the right atrium, it is possible to significantly reduce the amount of blood loss.

Reimplantation of stimulating system was performed in all patients. The endocardial reimplantation was performed in 19 patients for 7 or 10 days after the removal of the infected system. Epicardial system implanted simultaneously with the removal of a compromised system in 27 patients.

Conclusions:

The algorithm of choice of optimal method of extracting of endocardial electrodes during open-heart surgery showed a high efficacy and safety of use in clinical practice.