5.) Procedure times and treatment endpoints required for therapy
The analysis of time intervals for diagnosis, initiation of therapy,
hospital transfer, operative care, and post-operative treatment period
showed that a considerable amount of time had lapsed until patients
received final surgical treatment in all groups. It took a median of 14
(EL) to 19.5 (SR) days after diagnosis before patients were transferred
to our hospital. Here, the process was expedited, and final surgical
care could be provided after of 1 (SR) to 3 (EL) days. Postoperatively,
none of the study groups had a prolonged intensive care unit stay (0 to
0.5 days), while the longest subsequent stay on regular ward was seen in
the EL group with 14 days. Patients in the SI group were discharged home
most frequently (84.9%), whereas only half of the other two groups were
able to do so (SR: 48.3%; EL: 46.4%). All other patients had to be
transferred to other hospitals for further treatment.
During the hospital stay, two patients (2.2%) in the SR group died from
fulminant sepsis, which, in addition to terminal heart failure,
developed into dialysis-dependent cardio-renal syndrome with right heart
and liver failure and electrolyte imbalance. In the EL group, three
patients died (10.7%) during in-hospital stay. One patient died due to
a fulminant pneumogenic septic with dialysis-dependent anuria and
multi-organ failure. Another patient developed a methicillin-resistant
staphylococcus aureus (MRSA) mediastinitis and an enterococcus faecalis
lead endoplastitis following a coronary artery bypass (CABG) and aortic
valve operation. Despite the immediate removal of the foreign material,
the septic process could not be averted and the patient died in
fulminant septic shock. A third end-stage heart failure patient with a
streptococcus sanguis pocket infection died in terminal heart failure
following a primarily uncomplicated CRT system extraction due to the
postoperative lack of biventricular pacing. In the SI group, there was
only one death (1.4%). This occurred in a stimulation-dependent patient
with renal failure who experienced an unclear gastrointestinal
complication with severe vomiting following the primary uneventful
removal of the system and contralateral device implantation. This
resulted in cardiac arrest due to electromechanical uncoupling, which
led to death (Table 3).