Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction.
Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction.
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DOI：
10.4022/jafib.1455
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发表时间：
2016-10-01
影响因子：
--
通讯作者：
Conrad, John
中科院分区：
文献类型：
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作者：
Schaerf, Raymond H M;Najibi, Sasan;Conrad, John
该病例系列报告了我们在脓毒症心脏植入式电子器械（CIED）电极导线拔除过程中安全清除大赘生物的微创经皮方法的早期经验。关于涉及这些装置的植被管理存在争议。对于感染，必须拔除电极导线，但赘生物可能栓塞，导致并发症。建议进行外科清创术;替代方法包括心肺转流术、微创开胸术或经心房入路。AngioVac器械允许在超声心动图和荧光镜引导下经皮右心旁路和抽吸清除赘生物。该病例系列描述了我们的前20例患者，尽管长期使用抗生素，但均患有持续性脓毒症和赘生物的危重患者。该系列包括因禁忌症而不符合替代手术条件的患者，并强调了这项新技术的潜在作用。
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.