title: Safety and feasibility of biventricular devices reuse in general and elderly population--a single-center retrospective cohort study.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is known to have very important beneficial effects on heart failure patients. Unfortunately, biventricular implantable cardiac devices (CRT devices), through which this therapy is implemented, are very expensive and sometimes hard to achieve, especially in underdeveloped/developing economies, making this an important problem of public health. As a possible solution, CRT reuse is of great interest nowadays, but unlike simple devices, data in the literature are scarce about biventricular device reuse.
  
  
  OBJECTIVE
  To address safety concerns, we aimed to analyze infection burden in the general and elderly population and also early battery depletion and generator malfunction of resterilized biventricular devices compared to new devices.
  
  
  METHODS
  A cohort of 261 CRT patients (286 devices), who underwent implantation between 2000 and 2014, was retrospectively analyzed. The study group included 115 patients and 127 resterilized devices, that was divided into a subgroup of 69 elderly patients (≥60 years) and 74 devices and a subgroup of 47 younger patients (<60 years) and 53 devices, and the control group included 146 patients and 159 new devices. The groups were compared using a multivariate logistic regression model.
  
  
  RESULTS
  A number of 12 (4.2%) infectious complications were encountered, five (3.9%) in the study group and seven (4.4%) in the control group (odds ratio, 2.83 [0.59-13.44], P=0.189), one (1.3%) in the elderly and four (7.5%) in the younger subgroup (odds ratio, 3.80 [0.36-40.30], P=0.266), with no statistically significant difference between them. There was only one case of early battery depletion, after 17 months, in one study group patient. No generator malfunction was detected.
  
  
  CONCLUSIONS
  Reuse of biventricular cardiac implantable electronics seems feasible and safe in both the general population and the elderly population, and it could be a promising alternative when new devices cannot be obtained in a safe period of time.
authors: Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Raluca
authors: R
authors: Şoşdean
authors: Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Cristian
authors: C
authors: Mornoş
authors: Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Bogdan
authors: B
authors: Enache
authors: Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Răzvan I
authors: RI
authors: Macarie
authors: Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Raluca
authors: R
authors: Ianoş
authors: Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Ana-Maria
authors: AM
authors: Ştefea
authors: Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania.
authors: Sorin
authors: S
authors: Pescariu
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D003141:Communicable Diseases / Q000635:transmission; D017743:Equipment Reuse; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: biventricular implantable cardiac devices; infectious complications; malfunction; reuse