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Journal of Arrhythmia Jun 2016The subcutaneous implantable cardioverter defibrillator (S-ICD) is a novel device now accepted in clinical practice for treating ventricular arrhythmias. In 14...
The subcutaneous implantable cardioverter defibrillator (S-ICD) is a novel device now accepted in clinical practice for treating ventricular arrhythmias. In 14 consecutive patients, S-ICD devices were placed in the virtual space between the anterior surface of the serratus anterior muscle and the posterior surface of the latissimus dorsi muscle. During a mean follow up of 9 months, no dislocations, infections, hematoma formations, or skin erosions were observed. Intermuscular implantation of the S-ICD could be a reliable, safe, and appealing alternative to the standard subcutaneous placement.
PubMed: 27354870
DOI: 10.1016/j.joa.2016.01.005 -
Journal of Cardiology Cases Aug 2018The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and...
The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and expansion of indications for CIEDs have led to an increase in associated infections. We experienced a case of a 99-year-old man presenting with skin erosion at the pocket site, where a 6-month-old implantable pacemaker was replaced. He was referred for pacemaker pocket infection and presented with fever accompanied by pain and swelling around pacemaker generator. We could not explant 7-year-old pacemaker leads and the patient refused to undergo either laser lead extraction or surgical removal. We planned to re-implant in the contralateral chest. However, the patient was emaciated with low body-mass-index (15.2 kg/m), thus concerns arose about the possibility of tissue disruption and re-infection owing to thin skin and absence of sufficient subcutaneous tissue in contralateral subclavian region. Axillary placement of CIEDs has been adopted in patients with limited venous access. We applied a mid-axillary pacemaker implant procedure to this elderly and emaciated patient. Postoperative clinical course was uneventful. After discharge, no history of unexplained fever or illness was recorded. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation. < We apply the mid-axillary pacemaker implant procedure to a nonagenarian with contralateral pacemaker infection to minimize the risk of skin disruption after implantation. This implies that implantation is possible in patients with emaciated or cachexic or infection of the contralateral subclavian pocket. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation.> .
PubMed: 30279914
DOI: 10.1016/j.jccase.2018.04.008 -
Journal of Interventional Cardiac... Aug 2022The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of... (Review)
Review
BACKGROUND
The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of complications, experience of how to manage them is limited. In this paper, we describe generator- and lead-related complications recorded in a series of S-ICD patients, and we propose our conservative approach to managing them.
METHODS
The study cohort consisted of S-ICD patients who were referred to our institution owing to generator- or lead-related complications requiring surgical intervention. With our "shift and cover" approach, the system component involved is moved from its original position to an alternative, more protected location. In the case of the generator, this involves moving it to an intermuscular pocket. In the case of infections at the parasternal scar, the electrode sleeve is moved away from its original location, stitched, and then covered with the muscular fascia.
RESULTS
Fourteen S-ICD patients were referred to our institution owing to system-related complications. Complications involved the generator in 7 cases (deep pocket infections with erosion, extrusion, or pain), the lead in 5 cases (parasternal infections at the xyphoid incision site), and both the generator and the lead in 2 cases. Complications were managed without completely removing the device and resolved in a single surgical session with no intraoperative complications. During defibrillation testing, the first shock at 65 J was effective in all patients. The shock impedance after revision was significantly lower than that measured during first implantation (59 ± 10 Ohm versus 86 ± 24 Ohm, P = 0.013). In all cases, the cosmetic result was satisfactory. No complications or recurrent infections were reported at the 12-month follow-up visit.
CONCLUSIONS
The proposed conservative approach was successful in managing S-ICD complications. The revision procedure allowed to optimize the system configuration in terms of the defibrillation vector, resulting in lower shock impedance values and better device positioning.
PubMed: 35927601
DOI: 10.1007/s10840-022-01312-y -
Pacing and Clinical Electrophysiology :... Oct 1996ICD therapy for life-threatening arrhythmias is well established. As more patients are treated, the incidence of recognized and new complications may increase. We report...
ICD therapy for life-threatening arrhythmias is well established. As more patients are treated, the incidence of recognized and new complications may increase. We report ICD pocket erosion and migration of the pulse generator into the peritoneal cavity in two patients.
Topics: Defibrillators, Implantable; Foreign-Body Migration; Humans; Male; Middle Aged; Peritoneal Cavity; Tomography, X-Ray Computed
PubMed: 8904551
DOI: 10.1111/j.1540-8159.1996.tb03173.x -
Biomaterials Nov 2013Hydrogels have been extensively studied as a carrier of various hydrophilic molecular compounds and cells for local delivery and subsequent controlled release. One of...
Hydrogels have been extensively studied as a carrier of various hydrophilic molecular compounds and cells for local delivery and subsequent controlled release. One of key design parameters in the hydrogel assembly is an ability to control spatiotemporal gel degradation, in order to tailor release rates of multiple drugs and also regulate phenotypic activities of co-cultured cells. To achieve this goal, this study presents a simple but innovative implantable, microfabricated hydrogel patch that undergoes micropatterned surface erosion at controlled rates and subsequently discharges two molecular compounds of interests at desired rates. This device was prepared by first fabricating a non-degradable poly(ethylene glycol) dimethacrylate (PEGDMA) hydrogel patch containing micro-pockets of controlled spacing and subsequently filling micro-pockets with a hydrogel of poly(ethylene imine) (PEI) and PEG diacrylate (PEGDA) that was tailored to degrade at controlled rates. Separate incorporation of vascular endothelial growth factor (VEGF)121 and VEGF165, known to orchestrate vascular development, into the PEI-PEGDA gel and PEGDMA hydrogel resulted in enhanced neovascularization at the implantation sites due to bimodal, sequential release of two VEGF isoforms. We believe that the hydrogel patch fabricated in this study will be highly useful to better understand a broad array of complex biological processes and also improve the efficacy of molecular cargos in varied applications.
Topics: Animals; Chick Embryo; Chickens; Elastic Modulus; Hydrogel, Polyethylene Glycol Dimethacrylate; Polyethylene Glycols; Vascular Endothelial Growth Factor A
PubMed: 23886733
DOI: 10.1016/j.biomaterials.2013.07.026 -
Journal of Clinical Medicine Apr 2021Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for...
Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for refractory glaucoma. The new autologous scleral pocket technique is performed by inserting the tube into the vitreous cavity without using a donor scleral patch. The purpose of this study was to evaluate the surgical results of Ahmed glaucoma valve (AGV) implantation using this technique for neovascular glaucoma (NVG), which is one of the representative refractory types of glaucoma. This observational retrospective case series included 15 consecutive eyes of 15 patients with NVG who had undergone AGV implantation at Kobe University between January 2018 and December 2019. The mean preoperative intraocular pressure (IOP) was 37.2 ± 13.8 mmHg and the glaucoma drug score was 4.2 ± 2.2. The mean IOP and glaucoma drug score at 1 year postoperatively decreased to 15.0 ± 4.6 mmHg and 1.3 ± 2.0, respectively ( < 0.001). No significant change in the corneal endothelial cell density following surgery was observed ( = 0.09); however, one patient required an additional trabeculectomy at 7 months postoperatively. No cases of tube exposure or conjunctival erosion were observed at 1 year postoperatively. These results indicated the effectiveness and safety of this technique in patients with NVG.
PubMed: 33920094
DOI: 10.3390/jcm10081606 -
Ear, Nose, & Throat Journal Sep 2015
Topics: Adult; Chorda Tympani Nerve; Female; Hearing Loss, Conductive; Humans; Incus; Otitis Media with Effusion; Otoscopy; Tympanoplasty
PubMed: 26401664
DOI: 10.1177/014556131509400901 -
Indian Journal of Plastic Surgery :... Sep 2021Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free...
Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence. To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study. Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension. Twelve patients ( = 10; = 2) with a mean age of 65 years (range, 46-82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8-30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality. In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.
PubMed: 34667522
DOI: 10.1055/s-0041-1735417 -
Cureus Jan 2021Background The CanGaroo® Envelope (Aziyo Biologics, Silver Spring, MD) is intended to securely hold a cardiovascular implantable electronic device (CIED) to create a...
Background The CanGaroo® Envelope (Aziyo Biologics, Silver Spring, MD) is intended to securely hold a cardiovascular implantable electronic device (CIED) to create a stable environment when implanted in the body. Data on the utilization of this newly available product are limited. Objective In this study, our objective was to describe the specific profiles of patients who may benefit from the use of the CanGaroo® Envelope at the time of CIED implantation. Methods The utilization of the CanGaroo® Envelope was assessed from January 2019 to October 2019 among a series of patients who were either undergoing de-novo CIED implantation or replacement. Results Among a total of 50 patients, the CanGaroo® Envelope was utilized in 15 (30%). Three distinct patient profiles were identified: profile 1: elderly patients with poor tissue turgor at risk of wound dehiscence or erosion; profile 2: patients with a history of previous device infection; and profile 3: patients at high risk of device infection having one or more of the following risk factors - chronic kidney disease, immunocompromised state, or diabetes mellitus. At a mean follow-up of 18 ±3 months, no CIED pocket erosion, dehiscence, or infection was noted. Conclusions Three distinct profiles of patients who could potentially benefit from the use of the CanGaroo® Envelope were identified by the implanting physicians. Long-term follow-up data, including infection and wound dehiscence rates, are necessary to further analyze the optimal utilization of the device.
PubMed: 33604224
DOI: 10.7759/cureus.12702 -
Pacing and Clinical Electrophysiology :... Aug 1997
Topics: Foreign-Body Migration; Humans; Pacemaker, Artificial; Pectoralis Muscles; Seat Belts; Stress, Mechanical
PubMed: 9272548
DOI: 10.1111/j.1540-8159.1997.tb03616.x