Key result
Delaying CIED removal until simultaneous orthotopic heart transplantation, alongside suppressive antibiotic therapy, resulted in 0% infection recurrence in two patients.
Why the study?
While lack of CIED removal leads to recurrent infection, CIED removal carries major complication risks including death, raising questions about whether delaying removal until OHT is safe.
Is it safe to delay CIED removal until orthotopic heart transplantation with suppressive antibiotics in patients with CIED infection awaiting OHT?
Case Report (n=2)
Is it safe to delay CIED removal until orthotopic heart transplantation with suppressive antibiotics in patients with CIED infection awaiting OHT?
Delaying CIED removal until orthotopic heart transplantation while maintaining suppressive antibiotic therapy may be a safe approach in carefully selected patients.
May support delayed CIED removal until OHT with suppressive antibiotics in select cases; hypothesis-generating and requires prospective validation.
Cardiac implantable electronic device (CIED) infections are treated with antibiotics and device explantation. Lack of CIED removal is associated with infection recurrence. However, CIED removal can be associated with major complications including death. We reported two patients with advanced heart disease who developed CIED infection due Staphylococcus epidermidis while awaiting for orthotopic heart transplantation (OHT). Both patients were managed with a different approach. They were treated with antibiotic therapy and had their CIED removal postponed until OHT. Both patients were kept on suppressive antibiotic treatment until undergoing simultaneous OHT and removal of infected CIED. None of the patients had infection recurrence. Large studies are needed to assess whether the approach of delaying CIED removal until OHT is safe among carefully selected patients with CIED infection.
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Donato‐Santana et al. (2019) conducted a case report in Cardiac implantable electronic device (CIED) infection (n=2). Delaying CIED removal until simultaneous orthotopic heart transplantation with suppressive antibiotic therapy was evaluated on Infection recurrence. Delaying CIED removal until simultaneous orthotopic heart transplantation, alongside suppressive antibiotic therapy, resulted in 0% infection recurrence in two patients.
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