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Retained Lead Fragments in Superior Vena Cava and Early Post-Transplant Outcomes: A Single Center Preliminary
Federica Mazzone1, Lorenzo Giovannico1, Vincenzo Ezio Santobuono2
1Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
Insights
Retained cardiovascular implantable electronic device (CIED) lead fragments after heart transplantation are linked to increased early mortality. Strategies to minimize hardware risks are crucial for high-risk transplant candidates.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Devices
Background:
- Retained fragments of cardiovascular implantable electronic device (CIED) leads are common after orthotopic heart transplantation (OHT).
- The clinical significance of these retained lead fragments is not well understood.
Purpose of the Study:
- To investigate the association between retained CIED lead fragments and early post-transplant mortality.
- To determine if retained lead fragments are an independent risk factor for mortality after OHT.
Main Methods:
- A retrospective study of 179 adult OHT patients (January 2022 - January 2025).
- Identification of retained lead fragments using post-transplant imaging.
- Survival analysis comparing patients with and without retained fragments using Kaplan-Meier and Cox models.
Main Results:
- 16% of patients with pre-transplant CIEDs had retained lead fragments.
- Patients with retained fragments showed significantly lower survival at 30, 90, and 150 days post-OHT (log-rank p=0.002).
- Retained leads were independently associated with increased mortality (HR: 3.71; p=0.003).
Conclusions:
- Retained CIED lead fragments are an independent predictor of higher early mortality following OHT.
- These findings highlight the importance of intraoperative strategies to reduce hardware-related risks.
- Individualized approaches are recommended for high-risk transplant candidates to mitigate risks associated with retained CIED lead fragments.
Abstract:
Background/Objectives: Retained fragments of cardiovascular implantable electronic device (CIED) leads are frequently observed after orthotopic heart transplantation (OHT), but their clinical relevance remains unclear. Methods: We conducted a single-center, retrospective study of 179 adult patients who underwent OHT between January 2022 and January 2025. Post-transplant imaging was used to identify retained lead fragments. Patients were grouped based on the presence or absence of retained leads. The primary endpoint was all-cause mortality at 30, 90, and 150 days post-transplant. Survival analysis was performed using Kaplan-Meier estimates and Cox proportional hazards modeling. Results: Among 112 patients with pre-transplant CIEDs, 18 (16%) had retained intravascular lead fragments. These patients had significantly lower survival at 30 days (66.7% vs. 94.7%), 90 days (61.1% vs. 90.3%), and 150 days (55.0% vs. 83.5%) compared to those without retained fragments (log-rank p = 0.002). The presence of retained leads was independently associated with increased mortality (HR: 3.71; 95% CI: 1.55-8.84; p = 0.003), even after adjusting for potential confounders. Conclusions: Retained CIED lead fragments are independently associated with higher early post-transplant mortality. These findings support the need for individualized intraoperative strategies to mitigate hardware-related risks in high-risk transplant candidates.
