Infected implantable cardioverter-defibrillator lead extraction under deep hypothermic circulatory arrest; report of a case

• Published in: Kyobu geka. The Japanese journal of thoracic surgery Vol. 65; no. 10; p. 918
• Main Authors: Tarui, Tatsuya, Ikeda, Masahiro, Miyazu, Katsuyuki
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.09.2012
• Subjects: Circulatory Arrest, Deep Hypothermia Induced; Defibrillators, Implantable - adverse effects; Heart Arrest, Induced - methods; Humans; Male; Middle Aged; Prosthesis-Related Infections - surgery; Vena Cava, Superior
• ISSN: 0021-5252

We performed infected implantable cardioverter-defibrillator lead extraction under deep hypothermic circulatory arrest in a 58-year-old man. Venogram during the implantation of the lead had revealed complete obstruction of the innominate vein. Preoperative trans-esophageal ecocardiogram revealed intracardiac vegetation with a diameter of 20×13 mm. Because of advanced adhesion and large vegetation, we performed lead extraction under cardiopulmonary bypass. The leads were adherent to the wall of the superior vena cava( SVC) and the innominate vein and could not be extracted. So we converted to deep hypothermic circulatory arrest. We performed venotomy in the SVC and the innominate vein to achieve complete visualization. The leads were extracted under direct vision. Postoperative course was uneventful without recurrence. Extraction of implantable devices is highly recommended when infection occurs. When adhesion of the lead is suspected, safe extraction can be performed by venotomy of the innominate vein under deep hypothermic circulatory arrest.