Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction

Journal of Atrial Fibrillation
Raymond H M SchaerfJohn Conrad

Abstract

This case series reports our early experience with a minimally invasive percutaneous method of safely removing large vegetations during lead extraction in septic cardiac implantable electronic devices (CIED). Debate exists concerning the management of vegetations involving these devices. Lead extraction is mandated for infections, but vegetations may embolize, causing complications. Surgical debridement is recommended; alternatives include cardiopulmonary bypass, minimally invasive thoracotomy, or transatrial approaches. The AngioVac device allows percutaneous right heart bypass and suction removal of vegetations under echocardiographic and fluoroscopic guidance. This case series describes our first 20 patients, all critically ill with persistent sepsis and vegetations despite long-term antibiotics. This series includes patients who would not have been eligible for alternative procedures due to contraindications and highlights the potential role of this new technology.

References

Oct 22, 2003·Circulation·Larry M BaddourUNKNOWN AHA
Aug 1, 2006·Journal of the American College of Cardiology·Andrew VoigtSamir Saba
Aug 14, 2012·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Abhay A DivekarJoss D Fernandez

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Citations

Sep 25, 2018·Expert Review of Medical Devices·Christoph T StarckVolkmar Falk
Mar 8, 2019·Journal of Cardiac Surgery·Irbaz HameedMario Gaudino
Apr 27, 2019·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Akash RusiaRahul N Doshi
Jul 24, 2020·Journal of the American Heart Association·Hezzy ShmueliRobert J Siegel
May 21, 2019·Pacing and Clinical Electrophysiology : PACE·Soroosh KianiFaisal M Merchant
Oct 23, 2019·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Christoph T StarckVolkmar Falk

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