Management of pacemaker lead endocarditis with open heart surgery

Introduction and objectives. Infection of transvenous pacemaker leads is a serious complication which may produce septicemia, endocarditis or pulmonary embolism. Explantation of the entire pacemaker system either percutaneously or surgically is the preferred treatment. We report our experience in the management of pacemaker lead infection with open heart surgery. Patients and methods. Twenty-seven consecutive patients with pacemaker lead infection underwent complete system extraction with cardiopulmonary bypass at our Hospital between 2000-2006. Clinical, microbiological and surgical variables are analyzed. Results. Mean age was 66.7 +/- 11 years with a 74% of males. All patients had received previously antibiotics and 55% partial explant of the infected leads. The most frequent isolated germs were S. epidermidis and S. aureus. Vegetations were preoperative identified in 93.6% of cases by means of either transthoracic and/or transesophageal echocardiography. Hospital mortality was 3.7%. Postoperative acute renal failure which required transient hemodiafiltration occurred in 25.9% of cases. Prolonged mechanical ventilation was observed in 22%. No recurrence of endocarditis has been observed during follow-up. Conclusions. Surgical explant of the entire pacemaker system using cardiopulmonary bypass is an effective method to eradicate infection. Morbidity and mortality are significant. However, there are cases in which open heart surgery is the only possible technique to treat this condition and therefore it may be considered a routine therapeutic tool in conjunction with percutaneous techniques.