(CS-005) Utilizing Novel Transforming Powder Dressing to Avoid Explantation of Cardiovascular Implantable Electronic Devices (CIED)

The use of cardiac implantable electronic devices (CIEDs) has risen significantly in recent years; 1.25 million pacemakers are implanted annually worldwide.¹ In the United States alone, more than 300,00 people each year undergo surgical implantation of new CIEDs for treatment of cardiac disorders.² CIED related infections are estimated to occur at a rate of 1-2%, and are increasing in proportion to the rate of new CIED implantations.³  Infections often necessitate system explantation, posing substantial additional risks and costs to the patient and burden to the healthcare system.³

Methods:

This case series reports four patients who developed localized soft tissue infections with partial wound dehiscence after CIED insertion and were recommended to undergo explantation of their devices with contralateral system implantation. One patient had a pocket hematoma. All four underwent echocardiograms with no vegetations, blood cultures without bacteremia, and completed treatment with course of oral antibiotics without fevers. All elected serial wound care dressings with TPD rather than having CIED system explantation.³

TPD is a commercially available dressing comprised primarily of biocompatible polymers similar to those used in contact lenses. When hydrated with saline, TPD aggregates to form a moist, oxygen-permeable barrier that conforms to the wound bed. It covers and protects the wound while releasing excess exudate through vapor transpiration. TPD may be left on the wound for up to 30 days without requiring primary dressing changes.

Results:

Fresh applications of TPD were applied on average 2 to 3 times per patient for each of the four patients (50% male, age 35-79 years) that opted for TPD treatment rather than surgical explantation. All four surgical wounds healed in less than 7 weeks, avoiding CIED system explantation. No complications were observed.

Discussion:

Based on the outcomes, we conclude that when surgical site infection develops after CIED implants, with no vegetations or evidence of bacteremia observed, CIED superficial wounds infections may be effectively managed with TPD treatment without compromising healing outcomes. These results demonstrate that nonoperative methods of wound closure are feasible, pose less risk to the patient, and offer a significantly less costly alternative to CIED system explantation with contralateral system implantation.