Tissue adhesive as an alternative to pocket suture in cardiac implantable electronic devices

Background

Pocket infection is a feared complication of cardiac implantable electronic device (CIED) implantation. Aseptic technique and proper wound closure are essential for optimal wound healing. Tissue adhesives represent a modern, simple, rapid, and economically feasible method for surgical wound closure. Following application, the adhesive provides a firm wound seal and forms a film acting as a microbial barrier.

Purpose

To evaluate the incidence of early postoperative complications following the use of cyanoacrylate-based tissue adhesive for skin closure of CIED implantation pockets.

Methods

A total of 107 patients (mean age 71 ± 14.8 years; 62% male) in whom tissue adhesive was used for skin closure after CIED implantation between February 4, 2025, and July 22, 2025, were included. The subcutaneous layer was closed using standard absorbable sutures. Wound assessments were performed at 10 days and 3 months post-procedure. Risk factors potentially associated with impaired wound healing (diabetes mellitus, advanced chronic kidney disease, immunosuppressive therapy, and malignancy) were also assessed.

Results

Of the total cohort, 59 (55%) received pacemakers, 15 (14%) ICDs, 12 (11%) CRT-P/D devices, 10 (9%) implantable cardiac monitors (ICM), 8 (8%) CRT-P/D upgrades, and 3 (3%) CIED replacements including pocket revision. At least one comorbidity associated with impaired wound healing was present in 65 (61%) patients. Advanced (G3–5) chronic kidney disease was observed in 42 (39%), type 2 diabetes mellitus in 34 (32%), malignancy in 13 (12%), and immunosuppressive therapy in 5 (5%) patients.

The first post-implantation wound assessment after 10 day was attended by 85 (79%) patients, and the 3-month follow-up was completed by 101 (94%) patients. A total of 5 (5%) early wound complications were recorded—four cases of mild erythema and one case of minor wound secretion (three pacemakers, one CRT-D upgrade, one ICM). All complications resolved spontaneously without the need for antibiotic therapy or wound revision. No other wound-related complications were observed.

Conclusion

Based on our experience, the use of tissue adhesive for wound closure after CIED implantation is associated with excellent wound healing outcomes and represents a safe and effective alternative to conventional skin suturing.