Retained cardiac implantable electronic device fragments are not associated with magnetic resonance imaging safety issues, morbidity, or mortality after orthotopic heart transplant
Retained cardiac implantable electronic device fragments are not associated with magnetic resonance imaging safety issues, morbidity, or mortality after orthotopic heart transplant
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DOI：
10.1016/j.ahj.2017.04.011
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发表时间：
2017-08-01
影响因子：
4.8
通讯作者：
Kusumoto, Fred M.
中科院分区：
文献类型：
--
作者：
Austin, Christopher O.;Landolfo, Kevin;Kusumoto, Fred M.
背景心脏植入式电子设备治疗（CIED）已经彻底改变了晚期心力衰竭的治疗。大多数考虑进行原位心脏移植（OHT）的患者接受植入式心律转复器、心脏起搏治疗或两者兼而有之。这些CIED在移植时通过手术取出。有时，CIED未完全移除。鲜为人知的是，OHT后患者保留CIED fragments.Methods的结果，我们确定了200例连续OHT在我们的机构在2006年4月和2014年12月之间，并进行了回顾性分析，可用的影像学图像和临床记录。审查OHT前后的胸片是否存在CIED或残留CIED碎片。保留CIED片段，随后的磁共振成像（MRI）studiesperformed.Results一百八十200例患者的结果被确定为有CIED前OHT，其中29个保留CIED片段后OHT。大多数残留的CIED碎片来自上级腔静脉除颤器线圈。在保留CIED片段的队列中没有不良事件，生存率不受影响。10例患者保留CIED碎片安全进行了共28 MRI后OHT，所有的诊断quality.Conclusion保留CIED碎片与不良事件或增加死亡率后OHT。在不完全取出器械后保留CIED碎片的患者中安全进行了诊断性MRI。考虑到在该人群中已证明的安全性和保留的图像质量，在MRI之前回收这些碎片似乎没有必要。
Background Cardiac implantable electronic device therapy (CIED) has revolutionized treatment for advanced heart failure. Most patients considered for orthotopic heart transplantation (OHT) are treated with implantable cardioverter defibrillators, cardiac resynchronization therapy, or both. These CIEDs are surgically extracted at the time of transplant. Occasionally, CIEDs are incompletely removed. Little is known about the outcomes of post-OHT patients with retained CIED fragments.Methods We identified 200 consecutive patients that underwent OHT at our institution between April 2006 and December 2014 and performed a retrospective analysis of available radiographic images and clinical records. Chest radiographs prior to and following OHT were reviewed for the presence of CIED or retained CIED fragments. The outcomes of patients with retained CIED fragments that had subsequent magnetic resonance imaging (MRI) studies performed were further investigated.Results One hundred eighty of 200 patients were identified as having CIED prior to OHT, of which 29 had retained CIED fragments after OHT. Most retained CIED fragments originated from superior vena cava defibrillator coils. There were no adverse events in the retained CIED fragment cohort, and survival was unaffected. Ten patients with retained CIED fragments safely underwent a total of 28 MRIs after OHT, all of diagnostic quality.Conclusion Retained CIED fragments are not associated with adverse events or increased mortality after OHT. Diagnostic MRI has been safely performed in patients with retained CIED fragments after incomplete device extraction. Retrieval of these fragments prior to MRI does not appear warranted given the demonstrated safety and preserved image quality in this population.