Removal of infected pacemaker leads with deep hypothermic circulatory arrest and open surgical exploration of the superior vena cava and innominate veins

Despite the use of transvenous methods for extraction of infected leads, fa iled attempts may result in retained lead fragments. Retained lead fragment s may be a focus of continued infection leading to sepsis. We present two p atients in which conversion from cardiopulmonary bypass to hypothermic circ ulatory arrest allow ed direct visualization, using venotomies in the super ior vena cava and innominate vein to achieve! complete removal of retained pacemaker lead fragments. Use of venotomies in the extracardiac venous syst em is a technical addition to prior descriptions of lead extraction using d eep hypothermia and circulatory arrest.