Creation of the sole regional laser lead extraction program serving Atlantic Canada: initial experience.

BACKGROUND: An increasing need for laser lead extraction has grown in parallel with the increase of implantation of pacing and defibrillating devices. We reviewed the initial experience of a regional laser-assisted lead extraction program serving Atlantic Canada. METHODS: We retrospectively reviewed the cases of all consecutive patients who underwent laser lead extraction at the Maritime Heart Centre in Halifax, NS, between 2006 and 2015. We conducted univariate and Kaplan-Meier survivorship analyses. RESULTS: During the 9-year study period, 108 consecutive patients underwent laser lead extractions (218 leads extracted). The most common indication for extraction was infection (84.3%). Most patients were older than 60 years (73.1%) and had leads chronically implanted; the explanted leads were an average of 7.5 ± 6.8 years old. Procedural and clinical success (resolution of preoperative symptoms) rates and mortality were 96.8%, 97.2%, and 0.9%, respectively. Sternotomy procedures were performed in 3 instances: once for vascular repair due to perforation and twice to ensure that all infected lead material was removed. No minor complications required surgical intervention. Survival after discharge was 98.4% at 30 days and 94% at 12 months. CONCLUSION: Atlantic Canada's sole surgical extraction centre achieved high extraction success with a low complication rate. Lead extraction in an operative setting provides for immediate surgical intervention and is essential for the survival of patients with complicated cases. Surgeons must weigh the risks versus benefits in patients older than 60 years who have chronically implanted leads (> 1 yr) and infection.

CONTEXTE: La demande en matière d'extraction de sondes par laser a augmenté parallèlement à l'installation de stimulateurs et de défibrillateurs cardiaques. Nous nous sommes penchés sur les débuts d'un programme d'extraction de sondes par laser dans les provinces de l'Atlantique. MÉTHODES: Nous avons étudié rétrospectivement les dossiers de tous les patients consécutifs ayant subi une extraction de sondes par laser au Maritime Heart Centre à Halifax (N.-É), entre 2006 et 2015. Nous avons mené une analyse unidimensionnelle et une analyse de survie selon la méthode de Kaplan-Meier. RÉSULTATS: Pendant les 9 années à l'étude, 108 patients consécutifs ont subi une extraction de sondes par laser (218 sondes retirées). La cause d'extraction la plus fréquente était l'infection (84,3 %). La plupart des patients étaient âgés de plus de 60 ans (73,1 %), et leurs sondes avaient été installées de façon permanente. Les sondes extraites avaient été installées en moyenne 7,5 ± 6,8 ans plus tôt. Le taux de réussite de l'intervention, le taux de réussite clinique (soulagement des symptômes préopératoires) et le taux de mortalité se chiffraient respectivement à 96,8 %, à 97,2 % et à 0,9 %. Trois sternotomies ont dû être effectuées, dans 1 cas pour réparer les parois vasculaires à la suite d'une perforation, et dans les 2 autres cas pour s'assurer du retrait de tous les éléments infectés de la sonde. Aucune complication mineure n'a nécessité d'intervention chirurgicale. Le taux de survie après 30 jours et 12 mois suivant le congé des patients étaient de 98,4 % et de 94 %, respectivement. CONCLUSION: Le seul centre d'extraction de sondes dans les provinces de l'Atlantique obtient un taux élevé de réussite et un faible taux de complications. L'extraction de sondes en milieu opératoire permet de pratiquer immédiatement des interventions chirurgicales et est essentielle à la survie des patients dont les cas sont complexes. Les chirurgiens doivent évaluer les risques et les avantages pour les patients de plus de 60 ans qui montrent des signes d'infection et chez qui les sondes ont été installées depuis un certain temps (> 1 an).

Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study.

BACKGROUND: The management of hospital-acquired infections (HAIs) with respect to physician practices remains largely unexplored despite increasing efforts to standardize care. In the present study, we report findings from a 2-month audit of all patients that have undergone cardiac surgery at a large referral center in Atlantic Canada. METHODS: All patients who underwent cardiac surgical procedures during May and June 2013 at the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia were identified. The prevalence of urinary tract infections (UTIs), pneumonia, leg harvest site infections, superficial sternal wound infections, deep sternal wound infections, and sepsis was examined to determine physician approaches in terms of verification rates (microbiology), time of diagnosis and duration of treatment. Continuous variables were compared using Student's t-test and categorical variables were analyzed using Fischer's exact test. RESULTS: A total of 185 consecutive patients underwent cardiac surgical procedures, of which 39 (21%) developed at least one postoperative infection. The overall prevalence of infection types, from highest to lowest, was UTI (8%), pneumonia (7%), leg harvest site infection (5%), superficial surgical site infection (4%), and sepsis (2%). There were no deep sternal wound infections. The overall in-hospital mortality rate was 3.8% with a median length of stay (LOS) of 8 days. The overall infection verification rate was 50% (ranged from 100% in sepsis to 10% in leg harvest site infections). In all cases, a full course of antibiotics was administered despite negative microbiology cultures or limited evidence of an actual infection. CONCLUSIONS: HAIs are commonly treated without being verified and treatment is often not discontinued after negative cultures are received. Our findings highlight the fact that antibiotic treatment is not always supported by evidence, and the effect of this could contribute to increased selective pressure for antimicrobial resistant bacteria.