Study procedures
Initially, subjects underwent a transesophageal echocardiogram and blood
cultures to guide extraction and antibiotic therapy. Periprocedural
anticoagulant management varied according to individual characteristics;
in patients with mechanic mitral valves, warfarin was continued, and the
procedure was performed with an INR 2-3, but patients on direct oral
anticoagulants received the last dose at least 24 hours before the
procedure. Oral anticoagulation was restarted 24 hours after the
procedure if the patient did not develop a hematoma. All patients
underwent complete hardware removal under general anesthesia using
manual dilator sheaths (Sightrail® or Visisheath®, Spectranetics,
Colorado Springs, CO, USA), mechanical rotating dilator sheaths
(Tightrail®, Phillips Healthcare, Amsterdam, Netherlands), or
laser-powered sheaths (Guidelight, Phillips Healthcare, Amsterdam,
Netherlands) along with locking stylets (LLD, Phillips Healthcare,
Amsterdam, Netherlands). Complete procedural success was defined as the
removal of all targeted leads and material without permanently disabling
complications or procedure-related death. Clinical success was defined
as the retention of a small portion of a lead (<4 cm) that did
not negatively impact the outcome goals of the procedure.(12) Tissues
extracted from the generator pocket and lead tips were sent for culture.
In both groups, antibiotic irrigation was discouraged, as it has not
shown any improvement in procedure-related infections.(13) All
procedures were approved by the institutional review board.