Driveline infections in left ventricular assist devices: implications for destination therapy.
| Autor: | Sharma V; Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA. sharma.vikas@mayo.edu, Deo SV, Stulak JM, Durham LA 3rd, Daly RC, Park SJ, Baddour LM, Mehra K, Joyce LD |
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| Jazyk: | angličtina |
| Zdroj: | The Annals of thoracic surgery [Ann Thorac Surg] 2012 Nov; Vol. 94 (5), pp. 1381-6. Date of Electronic Publication: 2012 Jul 20. |
| DOI: | 10.1016/j.athoracsur.2012.05.074 |
| Abstrakt: | Background: Infection is one of the major limitations to successful long-term support after ventricular assist device implantation. There are limited data specifically examining the incidence and predictors of driveline infections (DLI), with a changing treatment paradigm toward destination therapy (DT) and longer duration of support. Methods: Between January 2007 and 2011, 143 patients underwent HeartMate II (Thoratec, Pleasanton, CA) implantation, with 87 (61%) as DT. Driveline maintenance strategy included sterile dressing changes with chlorhexidine and saline application, without prophylactic oral antibiotics. Results: DLI developed in 18 patients (12%) at a median of 182 days (range, 26 to 1,138 days) after implantation, among which 12 (66%) were from the DT cohort. Infections were superficial in 15 (82%) and deep in 3 (18%). Trauma was documented in 6 patients (33%). Seven patients (38%) needed readmission for DLI. Surgical debridement was needed in 3 (17%). All patients were managed successfully, without the need for device explantation or urgent cardiac transplantation. No patient required continuous antibiotic prophylaxis after the infection subsided. Risk factor analysis identified duration of support as the only independent predictor of infection (mean. 600 vs 390 days; p = 0.03). The odds of having a DLI rose by 4% for every month of support. Conclusions: Longer duration of support significantly increased the risk of DLI and hence increased the risk of DLI in patients with DT. DLI may be successfully managed with antibiotics and local wound care. Most of the infections were superficial, and progression to deep pocket or pump infection is rare in our experience. (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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