OPERATION PERFORMED:
1. Extraction of right ventricular ICD lead.
2. Extraction of right atrial pace/sense lead.
3. Extraction of left ventricular pace/sense lead.
4. Extraction of biventricular ICD pulse generator.
ANESTHESIA:
Versed 2 and fentanyl 75.
PREOPERATIVE DIAGNOSIS:
Methicillin-sensitive Staph endocarditis.
POSTOPERATIVE DIAGNOSIS:
Methicillin-sensitive Staph endocarditis.
ESTIMATED BLOOD LOSS:
10.
CONTRAST:
Zero.
COMPLICATIONS:
None.
SPECIMENS TAKEN:
1. RV ICD lead tips sent for culture.
2. Right atrial lead tip sent for culture.
3. Left ventricular pace/sense lead sent for culture.
INDICATION FOR PROCEDURE:
Briefly, Mr. Javier Marquez is a 62-year-old gentleman, past medical history of
diabetes, hypertension, hyperlipidemia, ischemic cardiomyopathy, coronary
artery disease with prior stenting and Medtronic biventricular ICD implanted in
January 2018 for primary prevention strategy. He is admitted for
methicillin-sensitive Staph endocarditis. TEE suggestive of vegetation on the
ICD lead. He is seen and examined, deemed appropriate for extraction of ICD
PATIENT NAME: MARQUEZ,JAVIER IGNACIO ACCOUNT #: AD0227779103
leads as well as generator.
PROCEDURE AND FINDINGS:
The patient was brought to the EP lab in a postabsorptive state. Informed
consent was given by the patient prior to the procedure and confirmed.
Intravenous prophylactic antibiotics were administered prior to the procedure.
After the site of implantation was prepped and draped in the usual sterile
fashion, after adequate anesthesia was given, the skin was infiltrated with 1%
lidocaine and 1% bupivacaine mixture. The skin was incised with a plasma
blade. Blunt and electrosurgical dissection was carried out to the level of
the prepectoral fascia with careful attention paid to hemostasis. The pocket
housing the ICD pulse generator and leads was opened using blunt and
electrosurgical dissection. There was no evidence of pus within the ICD
pocket. The leads were disconnected from the pulse generator. Straight stylet
was advanced into the right atrial and right ventricular lead. The active
fixation mechanisms were retracted. With gentle traction and under
fluoroscopy, the RV ICD lead was removed. Subsequently, the right atrial pace
sense lead was then removed without difficulty. Lastly, the left ventricular
pace sense was extracted with gentle traction as well. The lead tips were
severed and sent for culture. The patient remained hemodynamically stable
throughout the procedure.
The pocket was copiously irrigated with antibiotic containing normal saline and
subsequently observed. The pocket was closed with multiple interrupted layers
of 2-0 Vicryl. It was then closed superficially with 1 layer of continuous
suture using 3-0 Vicryl, staples, Telfa, and Tegaderm.
Extracted Medtronic ICD pulse generator serial number RPE217496H.
Extracted right atrial lead Medtronic model 5076, serial number PJN4606738.
Extracted RV ICD lead Medtronic model 6935, serial number TDL230498V.
Extracted LV pace sense lead Medtronic model 4298, serial number QUA538209V.
CONCLUSION:
1. Successful extraction of Medtronic biventricular ICD.
2. There was no evidence of pus within the ICD pocket.
3. There were no obvious vegetations adherent to the leads at the time of
extraction.
4. All lead tips have been sent for culture.
5. He can be discharged home with a LifeVest and a new biventricular ICD can be
implanted on the right side following completion of IV antibiotic therapy for
endocarditis.
6. Follow up with me in clinic in 10 days for removal of staples.