RT-101
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Infectious complications of ICD
implantations: prevention and treatment
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Francesco Siclari, Thorsten
Schmidt.
Department of Cardiac Surgery, Städtische Kliniken, Oldenburg, Germany
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Abstract
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Infective complications after ICD implantation
represent a dangerous and frightened complication. In the last few years the technical
features of the ICD have changed (biphasic shock waves, smaller size, reliable transvenous
electrodes) and the implantation technique has become easier. The non thoracotomy approach
(transvenous sensing and defibrillating) has progressively gained popularity.
We have reviewed the literature from 1992 to 1997 to find out which impact the new non
thoracotomy approach would have on the infection incidence. In 13 published papers dealing
with a total of 2712 patients the infection incidence in patients operated through a
thoracotomy was 4.6% (0-5.8), whereas in the non thoracotomy approach was 2.0% (0.8-3.8).
The interval between operation and infection varied between 3 days up to 18 months. The
most common microorganism involved was the staphylococcus aureus isolated in 58% of the
cases. Explantation of the infected system was performed primary in 85% of the cases. The
first manifestation of the infection was extrathoracic in 91% of the cases. No diagnostic
tool was reliable in ther early detection of infection.
In conclusion non thoracotomy approach has lead to a significant decrease of the
infection incidence. Prophylaxis, especially in form of antiseptic or antibiotic
irrigation of the ICD component before implantation seems to be of great importance in
avoiding infection.
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Key Words
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Implantable cardioverter defibrillator –
therapy
infectious complications, non-thoracotomy/thoracotomy approach, prevention, treatment,
staphylococcus aureus, R
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