The Refurbished Puise Generator

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Abstract
With the advent of long‐life lithium puise generators, normally functioning puise generators with a potential life of more than five years have been removed from patients and become available for re‐implantation. Although puise generator refurbishing is widely employed, the practice has not been accepted in the United States. At The Royal Melbourne Hospital, all lithium puise generators removed because of patient death or other causes were washed in a quaternary ammonium compound and soaked in formaldehyde. Puise generators were then electronically tested and, if within specification, were made available for re‐implantation. Puise generators were then washed under sterile conditions in distilled water and gas‐sterilized with ethylene oxide. Between 1975 and 1978 (48 months), 600 puise generators were implanted and 93 puise generators removed. There were 56 deaths, 22 cases of pre‐erosion, erosion, or infec‐tion and 15 elective removals either due to lead problems or impending power source depletion. Eighty‐three (89%) puise generators were refurbished (14% of total implants). This included 12 puise generators refurbished on two occasions. Ten puise generators were returned to manufacturers, seven because of impending power source depletion, two with suspected electronic faults, and one with a damaged case. Two complications occurred in patients with refurbished puise generators. An infective process present with the previous puise generator spread to a new pocket. The other puise generator was removed 35 months post second implantation because of impending power source depletion. Primary infection or unusual tissue reactions did not occur. Puise generator refurbishing as described was found to be a safe and economic procedure.