Salvage of Cardiac Implantable Electronic Device Pocket Infection with Skin Erosion in Frail 92-Year-Old

Abstract

We reported the novel use of a taurolidine-containing antimicrobial solution in the successful salvage of a partially exposed and polymicrobially infected cardiac implantable electronic device pulse generator in a frail patient unfit for lead extraction. The old, salvaged device was entirely internalized, and there were no signs of recurrent infection at 9 months follow-up.

Keywords: cardiac implantable electronic device; revision; surgical site infection; taurolidine.

Figure 1

(a) Pulse generator protrusion through skin erosion (biofilm formation at the skin edges). (b) Initial elliptical incision around skin defect during salvage procedure. (c) Fibrous and subcutaneous tissues encasing the pulse generator and leads were only exposed after removal outside the patient’s body. (d) A new sub-pectoral pocket was fashioned. (e) The old pulse generator was re-attached to the old leads after ex vivo and in vivo sterilisation with TauroPace™ prior to insertion into the new sub-pectoral pocket.

Figure 2

(a) The skin edges were closed with interrupted sutures. (b) Skin removed and sent in for histopathology. (c) Suture fixation sleeves sent in for microbiology. (d) Fibrous lining surrounding pulse generator and leads sent in for histopathology. (e) The pocket and wound looked healthy with no sign of recurrent infection, underlying abscess formation, or skin erosion 7 days post procedure.