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Inderjeet Singh Monga

Command Hospital, India

Title: Single operator observational study of incidence of pocket site infection and safety of absorbable sutures for pocket closure of CIED

Abstract

This is a single operator observational study conducted between Jan 2017 till Dec 2020 in which  total of 365 patients who underwent device implantation (AICD/PPI/CRT-D etc) for various indications at different hospitals were included. Aim of the study is to present operator’s 4-year experience on safety of pocket closure using single absorbable subcuticular suture Vicryl 2-0.All 365 cases underwent pocket closure using 3 layers of single continuous absorbable subcuticular suture (Vicryl 2-0 in 364 (99.7%) and Monocryl 2-0 in 1 (0.27%) patient). 52 (14.2%) patients wereon dual antiplatelets, 9 (2.46%) patients were on oral anticoagulants. Age ranged from 4 years to 92 years (average age 66±1.6 yrs). 128 patients (35%) were female and 227 (65%) were males. 124 patients (33.9%) were diabetic. All patients received minimum 5 days in-hospital IV antibiotics and 96.7% patients were discharged on 5th post op day. Average in-hospital stay was 5.7 days. 12 (3.28%) patients developed pocket site infection with no mortality. In 4 patients, infection was superficial not communicating with pocket. It healed with prolonged antibiotics for 1 extra week. 8 (66.7%) of these patients underwent device reimplantation subpectoral on same side with help of reconstructive surgeon and 5 (62.5%) devices were salvaged. Thus 3 (0.82%) patients required device explantation and procedure completed from contralateral side same day. 2 (66.67%) of these were diabetic while 1 (33.33%) was on DAPT. Only 1 patient who underwent pocket closure using Moncryl 2-0, device was explanted. This is a single operator observational studyconducted between Jan 2017 till Dec 2020 in which total of 365 patients who underwent device  implantation (AICD/PPI/CRT-D etc) for various indications at different hospitals were included.Aim of the study is to present operator’s 4-year experience on safety of pocket closure using single absorbable subcuticular suture Vicryl 2-0.All 365 cases underwent pocket closure using 3 layers of single continuous absorbable subcuticular suture (Vicryl 2-0 in 364 (99.7%) and Monocryl 2-0 in 1 (0.27%) patient). 52 (14.2%) patients wereon dual antiplatelets, 9 (2.46%) patients were on oral anticoagulants. Age ranged from 4 years to 92 years (average age 66±1.6 yrs). 128 patients (35%) were female and 227 (65%) were males. 124 patients (33.9%) were diabetic. All patients received minimum 5 days in-hospital IV antibiotics and 96.7% patients were discharged on 5th post op day. Average in-hospital stay was 5.7 days.12 (3.28%) patients developed pocket site infection with no mortality. In 4 patients, infection was superficial not communicating with pocket. It healed with prolonged antibiotics for 1 extra week.8 (66.7%) of these patients underwent device reimplantation subpectoral on same side with help of reconstructive surgeon and 5 (62.5%) devices were salvaged. Thus 3 (0.82%) patients required device explantation and procedure completed from contralateral side same day. 2 (66.67%) of these  were diabetic while 1 (33.33%) was on DAPT. Only 1 patient who underwent pocket closure using Moncryl 2-0, device was explanted. 

Conclusions: Pocket closure using 3 layers of single continuous absorbable subcuticular suture Vicryl 2-0 has been found to be very safe and effective modality for pocket closure and also helps in reducing pocket infection. In our experience after using this suture device explantation rate was only 0.55% and device healing success rate was 99.45%. It is convenient for the patients too as total duration of in-hospital stay as well as post discharge visits are reduced significantly. It also gives aesthetic look which is especially appealing in young females. Monocryl 2-0 has not been found to be good alternative as device explantation rate using this suture was 100%. We also found that device salvage therapy using subpectoral pocket and negative pressure wound therapy by reconstructive surgeons has also shown success rate of 62.5%.

Biography

Inderjeet Singh Monga is presently working as interventional cardiologist and HOD cardiology at  Command Hospital Chandimandir. He has experience of performing more than 10,000 Interventional procedures including Angiography, PCI, PPI, AICD, CRT and peripheral interventions along with EP procedures. He is proficient in performing Rotational atherectomy, Intravascular Lithotripsy, Intravascular Imaging with IVUS and OCT as well as Coronary Physiology Indices like  FFR, IFR and RFR. He has also assisted around 35 TAVR cases. His special interest is in performing imaging-guided PCI in young acute coronary syndrome patients and management of Heart Failure patients. He has reasonable teaching experience as Associate Professor Cardiology Armed Forces Medical College (AFMC) Pune for DM Cardiology, PG, UG and BSc PMT students and is still continuing the same at Command Hospital, Western Command, Chandimandir. He is totally committed to practice of cardiovascular therapy in Coronary and Peripheral Interventions along with Cardiac Rhythm Management and Electrophysiology. Also, he has various research publications to his credit. He has been an active participant in various reputed national and international conferences including case presentation, abstract presentation and guest lectures.