Advertisement

Left ventricular assist pump pocket infection: conservative treatment strategy for destination therapy candidates

Abstract

Background

Heart failure is a major cause of mortality and morbidity, particularly among patients with advanced disease and no access to cardiac transplantation. LVAD implantation is not only a bridge-to-transplantation option for patients awaiting a heart donor, but is often used as bridge-to-destination therapy in patients unsuited for transplantation for various reasons. LVAD infection is considered the second-most common cause of death in patients who survive the initial 6 months on LVAD support. Few reports describe the indications for chronic suppressing antibiotic therapy, device exchange, methods for exchanging infected devices, post-exchange antimicrobial management status, and the outcomes of such patients.

Case presentation

This is the case of a 74-year-old male patient with numerous comorbidities who received urgent surgical management for severe heart failure with a HeartMate II. Six months later he developed an LVAD pump infection with methicillin-resistant Staphylococcus epidermidis, which was diagnosed with leucocyte scintigraphy. The patient received an omental graft over the LVAD and a chronic suppressive antibiotic regime. A marked leukocyte scintigraphy showed the infection’s regression 6 months after the initiation of antibiotic treatment.

Discussion

We concisely reviewed the driveline infections and the main aspects of the LVAD pump infection. We reviewed options for conservative and nonconservative management and showed that conservative management of the LVAD pump infection is possible.

Conclusions

There are no defined recommendations for the management of LVAD pump infection. This case is among the few in the literature showing that conservative treatment of an LVAD pump infection is possible.

Int J Artif Organs 2017; 40(3): 90 - 95

Article Type: REVIEW

DOI:10.5301/ijao.5000561

Authors

Elie Haddad, François-Xavier Lescure, Walid Ghodhbane, Laurent Lepage, Camille D’Humieres, William Vindrios, Yazdan Yazdanpanah, Patrick Nataf, Matthias Kirsch

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

This article is available as full text PDF.

  • If you are a Subscriber, please log in now.

  • Article price: Eur 36,00
  • You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.
  • If you are not a Subscriber you may:
  • Subscribe to this journal
  • Unlimited access to all our archives, 24 hour a day, every day of the week.

Authors

Affiliations

  •  Department of Infectious Diseases, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Medical Sciences and Nursing Campus, Beirut - Lebanon
  •  Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Paris - France
  •  Department of Infectious Diseases, Bichat Hospital, Paris - France
  •  Department of Cardiac Surgery, Bichat Hospital, Paris - France
  •  Department of Cardiology, Bichat Hospital, Paris - France
  •  Laboratory of Microbiology, Bichat Hospital, Paris - France
  •  Department of Cardiac Surgery, Lausanne University Hospital, Lausanne - Switzerland

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

No supplementary material is available for this article.