Abstract 15746: Chlorhexidine Irrigation Without Capsulectomy After Device and Lead Extraction in Patients With Cardiac Implantable Device Infection
Introduction: Pocket management after device removal is unclear in patients with cardiac implantable electronic devices (CIEDs) infection. Capsulectomy has been proposed to reduce the risk of reinfection, this procedure is time consuming and requires extensive tissue debridement with a potential higher risk of hematoma formation. Hypothesis: The use of chlorhexidine and saline pocket irrigation without capsulectomy is effective in the management of CIED related infection. Methods: Patients who underwent transvenous lead extraction without capsulectomy for CIED-related infection were included. After complete hardware removal, thorough scrubbing of the generator pocket with 20 cc of 2% chlorhexidine followed by irrigation with 1L of saline was undertaken. The pocket was dried using sterile drapes and the wound was closed with separate intradermal absorbable suture. Implantation of a new CIED device and antibiotic treatment were given according to treating physicians’ discretion. Patients were followed up for 6 weeks after the procedure, and then every 6 months. Results: Between July 1 st , 2013 and May 1 st , 2019, 34 patients (68.1±10.6 years; 13 female) were included. Median follow-up was 745.5 days (IQ range 444.5-1418 days). Lead or device extrusion (41%) was the most frequent indication for extraction. Additionally, 38% of patients had endocarditis. In 75% of cases, bacteria were isolated from blood, pocket or lead tip cultures. Gram positive bacteria were the most frequently found organisms (59% of cases). In total, 19 patients (56%) had a new device implanted after the procedure; mean follow-up for this group of patients was 1251.1±678.8 days. Average time between device extraction and implant of a new device was 26 days, with 11 patients (32%) having device implant in the following week after extraction, including three patients (9%) who underwent dual chamber pacemaker immediately after lead extraction. There were no immediate or 30-day complications associated with chlorhexidine use. During follow-up, no patients presented recurrent infection. Conclusions: The use of chlorhexidine and saline pocket irrigation without capsulectomy offered excellent results with no cases of reinfection and without taking the risk of hematoma formation.