Use of a novel bipolar sealer device in pocket infections: A case series.

Abstract

Cardiac implantable electronic device pocket infections require complete system removal. However, postoperative bleeding and hematoma can occur after extensive debridement and an optimal management strategy has yet to be defined. Following system removal and debridement, all pockets were treated with the Aquamantys bipolar sealer until hemostasis of the underlying tissue was achieved. Clinical characteristics, sealer application time, and postoperative outcomes were analyzed. Thirteen consecutive patients were included with an average age of 61.6 years and 8/13 were male. One patient had both pocket infection and systemic bacteremia. Explanted devices included three pacemakers, nine transvenous implantable cardioverter-defibrillators (ICD), and one subcutaneous ICD. The average number of leads extracted was 2.08 ± 1.04 with a median lead dwell time of 75 months (range, 1-265). Pocket tissue culture yielded Streptococcus anginosus (1), Pseudomonas aeruginosa (2), Staphylococcus epidermidis (1), Staphylococcus aureus (1), and no growth (8). Average time using the Aquamantys was 5.6 ± 2.75 minutes per patient. Twelve out of thirteen pockets were closed by primary intention with one pocket packed and left to heal via secondary intention. A Jackson-Pratt drain was used in three patients and removed within 3 days. There were no hematomas noted during the acute hospitalization or during follow up and all of the wounds healed completely. Use of a novel bipolar sealing device in lieu of traditional electrocautery provided rapid and durable hemostasis with the ability to close almost all of the pockets via primary intention.