開胸・人工心肺使用下における留置期間36年の感染ペースメーカリード抜去

Extraction of a 36-year-old Pacemaker Lead Using Cardiopulmonary Bypass

植込み型心臓電気デバイス（cardiovascular implantable electronic devices：CIEDs）感染は，生命予後に大きな影響を与える重大な合併症である．感染した経静脈リードには，経皮的または開胸手術による抜去が選択される1）．われわれは留置期間36年の感染リードを開胸・人工心肺使用下に抜去した1例を経験したので報告する．

A 78-year-old man underwent pacemaker implantation via the left internal jugular vein 36 years ago. After 30 years, a new device was implanted via the right subclavian vein and the old lead was cut and buried underneath the skin due to infection. This time, the patient presented with persistent lead infection of the left side. We chose open heart surgery to excise the old lead because of severe adhesion and surrounding calcification. The infected lead was completely removed using cardiopulmonary bypass without complication. Old pacemaker leads tend to develop adhesion and calcification within the innominate vein and superior vena cava, and therefore, it is often difficult to remove it with percutaneous technique. It was considered that open heart surgery was useful to excise a very old pacemaker lead.