The Annals of Thoracic Surgery
November 12, 2010
Pacemaker and Internal Cardioverter Defibrillator Lead Extraction: A Safe and Effective Surgical Approach
… perioperative stroke or valve thromboses are the most devastating complications, and some hematoma formation may have to be accepted rather than risk these complications. However, it would appear that heparin should be avoided in the perioperative period and that all efforts using homeostasis should be made to avoid hematoma and possible increased infectious complication.
A history of repeat procedure for battery depletion, device malfunction, or upgrade was present in 47% of the infected patients and in 20% of our noninfected patients (Table 1). Again, we cannot know the percentage of multiple implants that were present in the population from which our infected patients arose due to our 3-state referral area. However, Millennium Research Group  found that 23.9% of single-chamber pacemakers, 20.6% of dual-chamber pacemakers, and 28.3% of biventricular pacemakers represented replacements or repeat implant for upgrade. Thus, a 47% incidence of multiple implants in the infected group would suggest an association e implants and infections. This observation has been made by others. Catanchin and colleagues  found an almost fivefold increase in infection after repeat procedures rather than primary implants. Likewise, Harcombe and colleagues  found patients undergoing elective unit replacement were at particular risk of complications. The initial implant complication rate was 1.4% but rose to 6.5% at a repeat visit to the pocket . These complications were infection or erosion, a variant of infection.
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