Tauropace reduces infections in patients with heart failure and reduced ejection fraction after cardiac electronic implantable device implantation

Abstract Background Infections associated with implantable cardiac electronic devices (CIEDs) pose a significant health risk and their incidence is currently increasing, thus the importance of novel prophylactic interventions has recently been emphasized. TauroPace, an innovative taurolidine-containing solution specifically designed to eliminate microbial contamination on CIED surfaces, could represent a promising solution. Methods This prospective cohort study enrolled consecutive patients with heart failure and an ejection fraction ≤35%, who were referred to five University hospitals in Italy, to receive de novo, replacement or upgrading Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy with defibrillator (CRT-D). People with prior CIED infections were excluded. In all procedures, the pocket was irrigated with taurolidine. Based on the main risk factors for CIED-related infections identified in the literature (including heart failure, diabetes, chronic kidney disease, and individuals who underwent defibrillator implantation, especially upgrades or revisions), we performed a meta-analysis and meta-regression to assess the relationship between the magnitude of treatment effect and various predictors. To estimate the incidence of CIED infections in high-risk subgroups, we used the percentage of patients with diabetes, chronic renal failure, or those who underwent an upgrade, replacement or revision procedure in our cohort, along with other risk factors for CIED infections, as continuous variables, and we were able to modify our comparison parameters based on the actual percentage of risk factors we obtained. AIMS To investigate the ability of taurolidine to reduce CIED infections up to 12 months after surgery in high-risk patients with heart failure. Results The study included 150 consecutive patients (77% males, 60% with ischemic heart disease; median [IQR] age at implantation: 70 [63-78] years). The main risk factors were distributed as follows: 53 (35%) diabetics, 60 (40%) patients with chronic renal failure, 39 (33%) with atrial fibrillation in anticoagulants. Overall, 75 (50%) received ICD and 75 CRT-D, with 66 (44%) replacement procedures, 7 (5%) upgrades, and 77 (51%) de novo implantations. During the one-year follow-up period, only 1 patient developed an infection (five months after CRT-D replacement procedure, diabetic, 60 years-old). By comparing our risk factors to compare the infection rate from the literature, we estimated an incidence rate of 4.5%, significantly higher than our cohort (z-score -2.26, p value = 0.023). Conclusion Taurolidine has shown promising results, demonstrating a lower incidence rate of infections within our cohort of high-risk patients compared to those reported in the literature. Further data are needed to validate and confirm these initial findings.