Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2022; 14(3): 177-186
Published online Mar 26, 2022. doi: 10.4330/wjc.v14.i3.177
Risk profiles and outcomes of patients receiving antibacterial cardiovascular implantable electronic device envelopes: A retrospective analysis
David A Woodard, Grace Kim, Kent R Nilsson
David A Woodard, Kent R Nilsson, Department of Cardiology, Piedmont Heart Institute, Athens, GA 30606, United States
Grace Kim, Kent R Nilsson, Department of Medicine, Augusta University-University of Georgia Medical Partnership, Athens, GA 30606, United States
Author contributions: Woodard D led the conception, design, data collection and analysis, and drafting of the manuscript; Nilsson K and Kim G contributed their expertise to the analysis/interpretation of data and editing of the manuscript; and all authors accept accountability for the accuracy of this work, and drafted, revised, and approved the final version of the manuscript to be published within this journal.
Supported by Aziyo Biologics, Inc.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the WIRB-Copernicus Group®.
Informed consent statement: A waiver of informed consent and HIPAA due to the retrospective nature of this study was obtained. This study was conducted in accordance with the ethical principles in the Declaration of Helsinki and conducted according to United States and international standards of Good Clinical Practice in accordance with applicable Federal regulations, International Council for Harmonization guidelines, and institutional research policies and procedures.
Conflict-of-interest statement: Woodard D is a consultant for Aziyo Biologics, Inc. The other authors have no relevant financial relationships to disclose.
Data sharing statement: The dataset supporting the conclusions of this article is available upon reasonable request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: David A Woodard, MD, Doctor, Department of Cardiology, Piedmont Heart Institute, Piedmont Athens Regional Medical Center 242 King Ave Suite 210, Athens, GA 30606, United States. davidwoodard92464@gmail.com
Received: December 17, 2021
Peer-review started: December 17, 2021
First decision: January 25, 2022
Revised: February 8, 2022
Accepted: March 3, 2022
Article in press: March 3, 2022
Published online: March 26, 2022
Processing time: 94 Days and 10.6 Hours
Abstract
BACKGROUND

Cardiovascular implantable electronic devices (CIEDs) are implanted in an increasing number of patients each year, which has led to an increase in the risk of CIED infection. Antibacterial CIED envelopes locally deliver antibiotics to the implant site over a short-term period and have been shown to reduce the risk of implant site infection. These envelopes are derived from either biologic or non-biologic materials. There is a paucity of data examining patient risk profiles and outcomes from using these envelope materials in the clinical setting and comparing these results to patients receiving no envelope with their CIED implantation.

AIM

To evaluate risk profiles and outcomes of patients who underwent CIED procedures with an antibacterial envelope or no envelope.

METHODS

After obtaining Internal Review Board approval, the records of consecutive patients who underwent a CIED implantation procedure by a single physician between March 2017 and December 2019 were retrospectively collected from our hospital. A total of 248 patients within this period were identified and reviewed through 12 mo of follow up. The CIED procedures used either no envelope (n = 57), a biologic envelope (CanGaroo®, Aziyo Biologics) that was pre-hydrated by the physician with vancomycin and gentamicin (n = 89), or a non-biologic envelope (Tyrx™, Medtronic) that was coated with a resorbable polymer containing the drug substances rifampin and minocycline by the manufacturer (n = 102). Patient selection for receiving either no envelope or an envelope (and which envelope to use) was determined by the treating physician. Statistical analyses were performed between the 3 groups (CanGaroo, Tyrx, and no envelope), and also between the No Envelope and Any Envelope groups by an independent, experienced biostatistician.

RESULTS

On average, patients who received any envelope (biologic or non-biologic) were younger (70.7 ± 14.0 vs 74.9 ± 10.6, P = 0.017), had a greater number of infection risk factors (81.2% vs 49.1%, P < 0.001), received more high-powered devices (37.2% vs 5.8%, P = 0.004), and were undergoing more reoperative procedures (47.1% vs 0.0%, P < 0.001) than patients who received no envelope. Between the two envelopes, biologic envelopes tended to be used more often in higher risk patients (84.3% vs 78.4%) and reoperative procedures (62.9% vs 33.3%) than non-biologic envelopes. The rate of CIED implant site pocket infection was low (any envelope 0.5% vs no envelope 0.0%) and was statistically equivalent between the two envelope groups. Other reported adverse events (lead dislodgement, lead or pocket revision, device migration or erosion, twiddler’s syndrome, and erythema/fever) were low and statistically equivalent between groups (biologic 2.2%, non-biologic 3.9%, no envelope 1.8%).

CONCLUSION

CIED infection rates for biologic and non-biologic antibacterial envelopes are similar. Antibacterial envelopes may benefit patients who are higher risk for infection, however additional studies are warranted to confirm this.

Keywords: Cardiovascular implantable electronic device envelope; Defibrillator; Extracellular matrix; Implantable cardioverter-defibrillator; Infection; Pacemaker

Core Tip: This retrospective study was performed to determine risk profiles and clinical outcomes of patients who underwent cardiovascular implantable electronic device (CIED) procedures with a biologic or non-biologic antibacterial envelope, or no envelope. A total of 248 patient records were reviewed containing 89 biologic, 102 non-biologic, and 57 no envelope patients. Pre-procedurally, patients who received any envelope (biologic or non-biologic) were at higher infection risk than patients who received no envelope. Biologic envelopes tended to be used more often in higher risk patients than non-biologic envelopes. The rate of CIED pocket infection was low and equivalent between the two envelopes.