Mechanical Vacuum Aspiration and Debulking of Large Vegetations During Cardiac Implantable Electronic Device Extraction.

Abstract

Cardiac implantable electronic device (CIED)-related bacteremia necessitates device extraction, but if there are large lead-related vegetations, surgical extraction is recommended. The associated higher morbidity and mortality complicate the management of these patients. The aim of this study was to assess the outcomes of percutaneous mechanical debulking (PMD) of lead-associated vegetations using a manual vacuum aspiration device during CIED extraction. This was a retrospective analysis of patients from 3 centers undergoing CIED extraction with lead-associated vegetations between 2023 and 2025. Patients were separated into 2 groups: those in whom PMD was used or those in whom PMD was not used (controls). Clinical outcomes and surrogates of infection severity were assessed. Among the full 42-patient extraction cohort, 13 patients had adjunctive PMD (age 59.4 ± 14.0 years, vegetation size 2.1 ± 0.6 cm [69.2% were ≥2 cm], diagnosis-to-extraction time 10.5 ± 8.8 days, baseline white blood cell [WBC] count 15.3 ± 7.1 10⁹/L) vs 29 control patients (age 63.1 ± 13.3 years, vegetation size 1.7 ± 0.5 cm [34.5% were ≥2 cm], diagnosis-to-extraction time 8.0 ± 5.7 days, baseline WBC count 9.9 ± 4.9 10⁹/L). Extraction in both cohorts occurred without major complications. There was a significant change in WBC count postprocedure compared with baseline: in the control arm, WBC count increased (mean 21.1%; 27.6% had a >20% increase), whereas WBC count decreased in the PMD arm (mean 8.35%; only 7.7% had a >20% increase; P = 0.046). The postextraction hospital stay was shorter with PMD (8.4 ± 7.3 days vs 15.8 ± 14.5 days; P = 0.056). One-month mortality was 0% with PMD vs 14% (n = 4) in the control group (P = 0.401). In this contemporary study of PMD of large lead-associated vegetations, manual vacuum aspiration was feasible and appeared associated with better outcomes, including postoperative markers of infection severity, hospital stay, and, perhaps, mortality.