Mechanical vacuum aspiration improves outcomes after CIED extraction

Percutaneous mechanical debulking (PMD) of lead-associated vegetations using a manual vacuum aspiration device is feasible and appears to result in better outcomes for patients undergoing cardiac implantable electronic device (CIED) extraction, suggests a study.

Forty-two patients from three centres undergoing CIED extraction with lead-associated vegetations between 2023 and 2025 were included in this retrospective analysis. They were grouped into those in whom PMD was used or those in whom PMD was not used (controls). The investigators then assessed the clinical outcomes and surrogates of infection severity.

Of the patients, 13 had adjunctive PMD (mean age 59.4 years, vegetation size 2.1 cm, diagnosis-to-extraction time 10.5 days, baseline white blood cell [WBC] count 15.3 10⁹/L), and 29 were controls (mean age 63.1 years, vegetation size 1.7 cm, diagnosis-to-extraction time 8.0 days, baseline WBC count 9.9 10⁹/L). No major complications occurred during extraction in both cohorts.

A significant change from baseline was noted in WBC count after the procedure. WBC count increased in the control arm (mean 21.1 percent, 27.6 percent had a 20-percent increase) and decreased in the PMD arm (mean 8.35 percent, only 7.7 percent had a 20-percent increase; p=0.046).

Patients in the PMD arm had a shorter postextraction hospital stay (8.4 vs 14.5 days; p=0.056). Furthermore, none of those who used PMD died at 1 month as opposed to four in the control group (0 percent vs 14 percent; 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,” the investigators said.