1Herzzentrum Dresden GmbH an der TU Dresden Abteilung für Invasive Elektrophysiologie Dresden, Deutschland; 2Institute of Mathematics, University of Liège Liège, Belgien; 3Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin und Kardiologie Dresden, Deutschland
Background & Introduction
Patients undergoing an explantation of cardiac implantable electronic devices (CIED) receive either a primary or secondary wound closure or open wound treatment depending on departmental practice. To date, there is limited data on whether secondary wound closure or open wound treatment has any benefit in terms of future complications although it requires a more intensive wound care.
Material & Methods
Patients who underwent CIED explantation for system infection at the Heart Centre Dresden between 2016 and 2022 were retrospectively reviewed. From this cohort, patients diagnosed with pocket infection were isolated and divided into two groups:
(i) Patients who underwent primary wound closure with or without temporary use of a drain (PG), and
(ii) patients who underwent secondary wound closur or open wound management (SG).
(ii) patients who underwent secondary wound closur or open wound management (SG).
Patients were followed up by telephone contact for short and long term complications.
Results
387 patients underwent CIED explantation due to local or system infection at the Heart Centre Dresden. Of this cohort, 205 patients (135 female; 74.4 ±11.4 y.o.) had a pocket infection. In addition to local infection, 25.9% of all patients presented with a pocket perforation. The onset of infection was early (within 28 days) in 16.1%, intermediate (29 days - 1 year) in 50.2% and late (after 1 year) in 33.2%. Wound swabs and blood cultures were positive for pathogens in 61.0% and 14.1% respectively.
136 (65.9%) underwent primary wound closure, 69 (34.1%) underwent secondary wound closure or open wound management. Post-operative (p.o.) hematoma was present in 12.2% of the cases (6.6% of PG and 24.6% of SG). The risk of developing a p.o. hematoma was significantly more likely in the SG (OR=4.61; IC 95% :1.93 - 11.01).
Re-implantation occurred in 70.2%, including 25.7% of leadless pacemakers and 1.5% subcutaneous defibrillators. In 13.7% re-implantation was not indicated, 4.4% refused and 1.0% had contraindications.
Mean length of hospitalization was 12.4 ±8.9 days in the PG and 15.7 ±9.6 days in the SG (p=0.0083). A total of 24 (34.8%) patients were discharged with an open wound with or without vacuum treatment (0.74% of PG; 34.8% of SG).
Mean telephonic follow-up was 27 ±18 months in 147 cases (n1=99; n2=48). 91.8% of the cases had no pathological findings at follow-up. 2.7% developed a wound healing disorder (WHD) which was treated conservatively, 4.1% required revision, 0.7% explantation and 0.7% endocarditis.
| Complication | Total Number | PG (%) | SG (%) |
| WHD | 4 | 2.2 | 4.2 |
| Revision | 6 | 4.0 | 4.2 |
| Explantation | 1 | 0 | 2.1 |
| Endocarditis | 1 | 1.0 | 0 |
Table 1: Complications in the Primary (PG) vs. Secondary Group (SG)
Six (2.9%) patients died during hospitalization, 32 (22.1%) during follow-up. All deaths were unrelated to the wound infection or the re-implanted device. The average age of death was 84 ±9.5 years.
Summary & Conclusions
Management of CIED pocket infection with primary wound closure compared to secondary wound closure showed a statistically significant shorter hospital stay and reduced likelihood of post-operative hematoma, with no increase in long-term complication rates.