Cardiac devices that are harvested post-mortem, resterilized and reused are not associated with an increased risk of infection or device-related death compared with new devices, according to a new study in NEJM.

Patients living in low-income countries have limited access to life-saving cardiac devices. To address this issue, from 1983, the Montreal Heart Institute in Canada began sending pacemakers and implantable cardioverter–defibrillators (ICDs) that had been extracted post-mortem and resterilized to under-resourced countries and, in 2003, started to record outcomes of their device reuse programme in a prospective registry. These data were used to determine whether recycled devices were associated with increased infection or device-related death compared with new devices.

In total, 1,051 patients from the Dominican Republic, Guatemala, Honduras and Mexico who received recycled pacemakers or ICDs were included in the analysis and were matched in a 1:3 ratio to 3,153 controls from Canada who had a new device implanted. During the 2-year follow-up period, 21 infections (2.0%) occurred in patients who received a reused device compared with 38 infections (1.2%) in patients who received a new device (HR 1.66, 95% CI 0.97–2.83, P = 0.06). The only factor that was significantly associated with a lower risk of infection was younger age (HR 0.98 per year of age, 95% CI 0.97–0.99). No device-related deaths occurred in either group.

“The 95% confidence interval for the hazard ratio in the primary competing-risk analysis ranged from 0.97 to 2.83, which suggests that, in a larger study, the difference between groups might have been statistically significant,” caution the investigators. Nevertheless, they acknowledge that the absolute difference in risk between the two groups was very low (<1 percentage point).