Long-Term Outcome of Infective Endocarditis Involving Cardiac Implantable Electronic Devices: Impact of Comorbidities and Lead Extraction

Autor: Emanuele, Durante-Mangoni, Maria Paola, Ursi, Roberto, Andini, Irene, Mattucci, Ester E, Della Ratta, Domenico, Iossa, Lorenzo, Bertolino, Stefano, De Vivo, Sabrina, Manduca, Michele, Torella, Marisa, De Feo, Rosa, Zampino, The Monaldi Hospital Cardiovascular Infection Study Group
Přispěvatelé: Durante-Mangoni, Emanuele, Ursi, Maria Paola, Andini, Roberto, Mattucci, Irene, Della Ratta, Ester E, Iossa, Domenico, Bertolino, Lorenzo, De Vivo, Stefano, Manduca, Sabrina, Torella, Michele, De Feo, Marisa, Zampino, Rosa, The Monaldi Hospital Cardiovascular Infection Study Group, Null
Rok vydání: 2022
Předmět:
Zdroj: Journal of Clinical Medicine; Volume 11; Issue 24; Pages: 7357
ISSN: 2077-0383
Popis: (1) Background: Management of cardiac implantable electronic device-related infective endocarditis (CIED-IE) hinges on complete hardware removal. We assessed whether long-term prognosis is affected by device removal, considering baseline patient comorbid conditions; (2) Methods: A total of 125 consecutive patients hospitalized for CIED-IE were included in this retrospective analysis. Outcomes were in-hospital, one-year, and long-term mortality. There were 109 patients who underwent device removal, 91 by transvenous lead extraction (TLE) and 18 by open heart surgery (OHS); (3) Results: TLE translated into lower hospital mortality (4.4% vs. 22.5% with OHS; p = 0.03). Septic pulmonary embolism was the only independent predictor of in-hospital mortality (OR:7.38 [1.49–36.6], p = 0.013). One-year mortality was in contrast independently associated to tricuspid valve involvement (p = 0.01) and Charlson comorbidity index (CCI, p = 0.039), but not the hardware removal modality. After a median follow-up of 41 months, mortality rose to 24%, and was significantly influenced only by CCI. Specifically, patients with a higher CCI who were also treated with TLE showed a survival rate not significantly different from those managed with medical therapy only; (4) Conclusions: In CIED-IE, TLE is the strategy of choice for hardware removal, improving early outcomes. Long-term benefits of TLE are lessened by comorbidities. In cases of CIED-IE with high CCI, a more conservative approach might be an option.
Databáze: OpenAIRE
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