Three-stage treatment of late mediastinitis after implantation of left ventricular assist device

Scandroglio, Anna Mara; Potapov, Evgenij; Pieri, Marina; Arlt, G.; Falk, Volkmar; Krabatsch, Thomas

doi:10.1016/j.medin.2016.01.005

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Device exchange, however, is an invasive procedure requiring cardiopulmonary bypass, and may be too invasive, especially in patients of advanced age and who have multiple comorbidities. We do not routinely perform total LVAD exchange following driveline infections, but reserve it for those cases of infection with heart apex involvement resulting in bleeding . Many patients are not candidates for heart transplantation or the waiting list is very long, thus increasing the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of driveline infections in patients with left ventricular assist devices

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Surgical management of driveline infections in patients with left ventricular assist devices

et al. 2016

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“…Other strategies included device relocation, silver impregnated dressings, and implantation of antibiotic impregnated beads. Sixteen studies 7,9,[14][15][16]18,19,[25][26][27][32][33][34]39,41,42 reported utilization of NPWT, with one study 24 reporting success with the use of instillation NPWT.…”

Section: Resultsmentioning

confidence: 99%

“…Full-text review left 33 articles for qualitative analysis and review. 6–9,14–42 Due to aggregate, or inconsistent reporting of data, four articles were removed from quantitative analysis. 6,30,31,38 This left 29 studies, including 16 case reports and 13 retrospective studies or case series.…”

Section: Methodsmentioning

confidence: 99%

Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes

Clark

Swanson

Cai

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Infected Ventricular Assist Device (VAD)-associated wounds are common and associated with significant morbidity and mortality. The efficacy of hardware salvage utilizing flaps and negative pressure wound therapy (NPWT) remains understudied. We hypothesized that patients treated with flaps and/or NPWT would have higher hardware salvage rates compared with other surgical management strategies. Methods: A meta-analysis study evaluating VAD-associated wounds was performed following PRISMA guidelines. Primary predictor variables were flap-reconstruction (FR), NPWT, no FR, and infection location (mediastinum versus driveline). Primary outcomes were hardware retention (salvage) versus explantation, infection recurrence, or death. Twenty-nine studies were included. Standard statistical methods included logistic regression analysis. Results: Seventy-four subjects with nonsignificant demographic differences between cohorts were identified. Overall salvage was 59.5% in both driveline and mediastinum cohorts. Overall, NPWT significantly improved salvage compared with no NPWT [77.4% versus 46.5% respectively (P = 0.009)], and FR significantly improved salvage compared with no FR [68.6% versus 39.1% respectively (P = 0.022)]. Logistic regression analysis predicting odds of salvage by FR (area under curve = 0.631) was significantly three times higher (95% CI: 1.2-9.5) and predicting the odds for salvage by NPWT (area under curve = 0.656) was significantly four times higher (95% CI: 1.4-11.1) compared with other treatment. Conclusions: NPWT or flap reconstruction for treatment of threatened VAD hardware was associated with a significantly improved device salvage compared with other surgical strategies. Further study should focus on subgroup analysis of flaps utilized and synergistic treatment benefits.

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Surgical Treatment of Mediastinitis with Omentoplasty in Ventricular Assist Device Patients: Report of Referral Center Experience

et al. 2016

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Mediastinitis is more frequent in patients with implantable ventricular assist devices (VADs) than in other cardiac surgery patients and carries significant mortality. We report our experience with a stepwise approach including aggressive debridement, jet lavage, vacuum assisted closure dressing, and finally coverage with well-vascularized and immune-active omental flaps in VAD patients with infective mediastinitis. We retrospectively collected and analyzed data of patients with continuous flow VAD who underwent plasty with the omental flap because of mediastinitis at Deutsches Herzzentrum Berlin between January 1, 2008 and October 30, 2015. Eight hundred forty-five patients underwent VAD implantation during the study period. Omentoplasty due to infective mediastinitis was performed in 17 cases. Nine had a HeartWare HVAD as left ventricular assist device (LVAD), three patients had two Heart-Ware HVAD as biventricular assist device (BIVAD), four had a HeartMate II LVAD device, and one patient had a Berlin Heart Incor LVAD. The microorganisms most frequently isolated from the sternal wound were Gram-positive Staphylococcus spp. Four cases of bleeding requiring surgical revision were recorded: three of intraabdominal and one of wound bleeding. Eight patients (47%) survived, whereas the other nine patients (53%) died. Sixteen (94%) required intensive care unit admission, and median hospital stay was 21 (1-182) days. Postoperative renal failure requiring dialysis and septic shock requiring vasopressors were associated with hospital mortality (p = 0.009 and p = 0.05, respectively). Early surgical treatment of mediastinitis after VAD implantation with omentoplasty is a valuable strategy in an otherwise dead-end situation. Bleeding should be meticulously controlled in these anticoagulated and fragile patients.

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Three-stage treatment of late mediastinitis after implantation of left ventricular assist device

Cited by 3 publications

References 12 publications

Surgical management of driveline infections in patients with left ventricular assist devices

Surgical management of driveline infections in patients with left ventricular assist devices

Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes

Surgical Treatment of Mediastinitis with Omentoplasty in Ventricular Assist Device Patients: Report of Referral Center Experience

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