title: Frequency and sequelae of retained implanted cardiac device material post heart transplantation.
abstract: BACKGROUND
  Cardiac implantable electronic devices (CIEDs) have now become common therapeutic adjuncts for patients prior to orthotopic heart transplantation (OHT). Removal of the generator and the intracardiac components occurs at time of transplantation but removal of the intravascular portion of leads may be unsuccessful without specialized extraction equipment.
  
  
  METHODS
  We performed a retrospective audit of chest radiographs and clinical records of patients undergoing OHT at Green Lane and Auckland City Hospitals between 2002 and 2012.
  
  
  RESULTS
  At the time of transplant surgery, 56 of 100 patients had a CIED in situ. Hardware was retained postoperatively in 22 (39%), and the CIED had been in situ for 47 (interquartile range [IQR] 16-68) months for these cases, compared to 14 (IQR 3-24) months in those without. In two (9%) patients, the device generator was electively explanted during the week following OHT. There were no subsequent procedures undertaken to remove retained lead fragments. One (4%) had lead fragment embolization, one (4%) had endoluminal fragment migration, and one (4%) had lead fragment erosion into the mediastinum; all were asymptomatic and without adverse clinical sequelae. There was no infection associated with this hardware. The presence of retained lead fragments was not associated with additional mortality.
  
  
  CONCLUSIONS
  Retained lead fragments following OHT occur commonly, without adverse clinical events for this cohort; however, the long-term clinical implications remain uncertain. Complete removal of all CIED hardware should be attempted at the time of OHT, and when this is not possible leads should be left in a state that facilitates their removal at a later date if required.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.forename: Jamie
authors.initials: J
authors.lastname: Voss
authors.forename: Duncan
authors.initials: D
authors.lastname: Shannon
authors.forename: Peter
authors.initials: P
authors.lastname: Ruygrok
authors.forename: Nigel
authors.initials: N
authors.lastname: Lever
mesh_terms: D000328:Adult; D015984:Causality; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016027:Heart Transplantation / Q000295:instrumentation* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: defibrillation lead; heart transplantation; implantable cardioverter defibrillator; lead extraction