Table 4.
Progression of the 281 local infections (initial classification) according to the initial therapeutic approach performed at their initial presentation.
| Deaths n (%) |
Failures n (%) |
Healing n (%) |
Contralateral Recurrence n (%) |
Overall n |
|
|---|---|---|---|---|---|
| Local Surgery | |||||
| Exclusive antimicrobial treatment 1 | 0 (0.0) | 21 (58.3) | 15 (41.7) | - | 36 |
| Pocket debridement 2 | 0 (0.0) | 44 (74.6) | 15 (25.4) | - | 59 |
| Generator replacement and alternative system 2 | 0 (0.0) | 15 (100.0) | 0 (0.0) | 0 (0.0) | 15 |
| Various procedures 2 | 0 (0.0) | 42 (100.0) | 0 (0.0) | - | 42 |
| Transvenous Lead extraction | |||||
| Initial TLE 3 | 5 (3.8) | 3 (2.3) | 4 (3.1) | 117 (90.6) | 129 |
| Secondary TLE 4 | 3 (2.4) | 4 (3.2) | 3 (2.4) | 115 (92) | 125 |
| Total TLE | 8 (3.1) 5 | 7 (2.7) 5 | 232 (91.3) | 7 (2.7) 6 | 254 |
TLE: transvenous lead extraction. 1 Out of the 21 patients with failure, in 2, a local surgery was performed (with a new failure) followed by a final successful TLE (with complete healing), and in the remaining 19, TLE was performed with complete healing but contralateral recurrence in 3, in which a new successful extraction was performed. 2 Out of 101 patients, from these 116 with local surgical approaches (59 + 15 + 42) recurred after local surgery (one or more procedures): in 4, a chronic antimicrobial treatment was administered. Two of them progressed to systemic infections, with one dying and another one, after an unsuccessful TLE, underwent cardiac surgery and was finally cured. The other two died during the follow-up due to unrelated causes to the infection. The remaining 97 patients were subjected to TLE, registering two deaths due to the technique and one death due to acute left ventricular failure after extraction. 3 These patients initially underwent TLE as the initial therapeutic approach. 4 These patients underwent TLE after failed to other approaches. 5 Five patients died due to the technique (three for rupture of the superior vena, one from cardiac tamponade, and one from ventricular fibrillation during the extraction) and three during the immediate postoperative period due to non-related complications (one for a stroke and two for ventricular failure). 5 In 44 (17.3%) of 254 TLEs, the tracking was incomplete. The seven patients who relapsed after an incomplete extraction developed a systemic infection and six went to cardiac surgery, two of them died and the other one was in chronic suppressive antimicrobial therapy. 6 Four patients who developed an infection of the new implant underwent a new successful TLE, two healed with antimicrobial therapy and, in the remainder, a local approach (surgical debridement) was performed, with curation.