1Universitätsklinikum Jena Klinik für Herz- und Thoraxchirurgie Jena, Deutschland; 2Weill Cornell Medicine New York, USA; 3University of North Carolina Chapel Hill, USA; 4Universitätsklinikum Jena Klinik für Anästhesiologie und Intensivtherapie Jena, Deutschland; 5University of Toronto Toronto, Kanada; 6University of Pittsburgh Pittsburgh, USA; 7Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH Rotenburg an der Fulda, Deutschland; 8Universitätklinikum Jena Infektionsmedizin Jena, Deutschland
Background
Complete removal of cardiac devices (such as cardiac resynchronization therapy – CRT, implantable cardioverter-defibrillator – ICD and pacemaker – PM) is recommended for device infection. However, conservative therapy may be chosen in patients with severe comorbidities or if the infection was assessed to be mild.
Methods
We performed a systematic review and meta-analysis of studies reporting shortand long-term outcomes in patients who had a device infection or IE and underwent complete removal of cardiac device (generator and leads) compared to those who received conservative therapy (no removal, partial removal, local antibiotic infiltration or isolated antibiotic therapy). Three databases were assessed. Primary outcome was reinfection/relapse (mean-follow-up: 16.1 months). Secondary outcomes were short-term (30-day/in-hospital) and long-term (mean follow-up: 43.0 months) mortality. Random effects model was performed.
Results
Thirty-two studies met the criteria for inclusion in the final analysis. The pooled OR of the primary endpoint was strongly associated with lower rates of reinfection/relapse in the complete device removal group (OR 0.02, 95%CI 0.01-0.06, p<0.0001). In terms of mortality, complete device removal showed also lower rates in short (OR 0.40, 95%CI 0.23-0.69, p= 0.01) and long term (OR 0.52, 95%CI 0.34-0.78, p= 0.002).
Conclusion
The analysis suggest that when compared with the conservative therapy, patients who underwent complete device removal showed lower incidence of reinfection/relapse short-term mortality, and long-term mortality.