Novel Innovations for Ventricular Assist Device Infection

Abstract

Device infection is a major potential complication following ventricular assist device implantation and can lead to devastating consequences. The treatment options are few and often challenging to implement. The most durable option may require device exchange to obtain adequate source control. Due to the prolonged support times offered by the new left ventricular assist devices (LVADs), there is concern that the number of patients that will eventually require repeated device exchanges for device infection will increase. The benefit of medical antibiotic therapy alone is limited and is frequently unsuccessful. Surgical treatment strategies that improve outcomes by eliminating the infection and by preventing infection recurrence are needed. We report a case of a third-time LVAD exchange (4th device implant) for device infection within eight years of the index implant, and we briefly discuss the role of the greater omentum in the surgical treatment of this complication.

Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives

“…65 Reconstructive flaps have been described for hardware coverage following device exchange or debridement with resultant large defects, to fill dead space, improve perfusion and assist with antibiotic delivery. [64][65][66][67] The rectus abdominis myocutaneous flap has been utilized for this purpose, given its pedicle length and device proximity. 64,67 However, this muscle may not always be available for use if severed during device implantation or debrided in attempts for infection control.…”

“…66 The greater omentum has a robust vascular supply and immunological properties that may assist with both treatment and prevention of reinfection. 66,68,69 The plasticity of this structure allows for easy manipulation for surgical implantation. 66,68,69 Jacoby et al 64 describe a protocol for managing VAD infections refractory to antibiotic therapy, beginning with serial debridement, wound cultures and NPWT.…”

“…66,68,69 The plasticity of this structure allows for easy manipulation for surgical implantation. 66,68,69 Jacoby et al 64 describe a protocol for managing VAD infections refractory to antibiotic therapy, beginning with serial debridement, wound cultures and NPWT. Local tissue flap and driveline repositioning are then considered for resultant small defects with healthy adjacent tissue.…”

“…64,67,68 Transposition of the greater omentum has been utilized in cardiothoracic surgery for management of sternal wound infections and our center previously described its use in the management of VAD infections (Figure 1). 66 The greater omentum has a robust vascular supply and immunological properties that may assist with both treatment and prevention of reinfection. 66,68,69 The plasticity of this structure allows for easy manipulation for surgical implantation.…”

“…66 The greater omentum has a robust vascular supply and immunological properties that may assist with both treatment and prevention of reinfection. 66,68,69 The plasticity of this structure allows for easy manipulation for surgical implantation. 66,68,69…”