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. 2022 Dec 11;11(24):7357.
doi: 10.3390/jcm11247357.

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

Emanuele Durante-Mangoni  1   2 , Maria Paola Ursi  1   2 , Roberto Andini  1   2 , Irene Mattucci  2 , Ester E Della Ratta  2 , Domenico Iossa  1   2 , Lorenzo Bertolino  1 , Stefano De Vivo  2 , Sabrina Manduca  2 , Michele Torella  2   3 , Marisa De Feo  2   3 , Rosa Zampino  2   4 , The Monaldi Hospital Cardiovascular Infection Study Group
Affiliations

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

Emanuele Durante-Mangoni et al. J Clin Med. .

Abstract

(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.

Keywords: cardiac implantable electronic device; infective endocarditis; long-term mortality; predictors; transvenous lead extraction.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Kaplan–Meier curves describing survival probability, after one year of follow-up, according to the three therapeutic approaches used for CIED-related endocarditis: medical only, transvenous lead extraction (TLE), and open heart surgery (OHS).
Figure 2
Figure 2
Kaplan–Meier curves describing long-term survival probability according to therapeutic approach (medical only vs. TLE) and CCI < or ≥ the group median.
Figure 3
Figure 3
Kaplan–Meier curves comparing long-term survival probability of the two subgroups of patients with a CCI higher that the group median managed with medical therapy only vs. TLE.
See this image and copyright information in PMC

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