Device related infections: are we making progress?
ABSTRACT Infection was identified early in development of mechanical circulatory support devices (MCSDs) as an important cause of morbidity and mortality. Sepsis, infection of implanted pump components, and infections of percutaneous drivelines continue to limit survival and decrease quality of life for patients with a MCSD. This review examines five questions related to whether there has been progress in preventing or managing infection complications in patients with MCSDs. Have changes in patient selection, device design, and surgical implant techniques decreased the incidence of infection? Do smaller implanted blood pumps have a lower risk for infection than larger implanted blood pumps? Will fully implanted circulatory support systems have fewer infection complications than tethered MCSDs? Can optimal design of a driveline together with improvements in surgical techniques and care of the percutaneous driveline diminish the rate and consequences of driveline infections? Have improvements in the preoperative, intraoperative, and immediate postoperative management of patients with MCSDs decreased the risk of sepsis? Although infection remains an important problem for patients with MCSDs, there is evidence that we are making progress as described in this review. It is crucial that we continue.
- Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2009; 28(2).
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ABSTRACT: Implantation of the HeartMate Implanted Pneumatic or Vented Electric Ventricular Assist Device requires that the pump be implanted either in the peritoneal cavity or in the abdominal wall. Both sites have been problematic. We describe a new technique in which an intraperitoneal pocket is created, using Gore-Tex Dual Mesh Plus Biomaterial with Holes, to contain the ventricular assist device. This shields the ventricular assist device from the peritoneal contents and avoids abdominal wall dissection. Thirty consecutive patients who underwent implantation using this technique were compared with 16 patients who underwent implantation before this technique was in use. Thirty consecutive patients underwent implantation, and 2 of those patients underwent re-implantation because of device failure (16/30 HeartMate Implanted Pneumatic, 14/30 HeartMate Vented Electric, and 2/14 HeartMate Vented Electric replaced with the HeartMate Implanted Pneumatic). Twenty-five patients have undergone explantation. Pocket infections in patients who have had implanted devices for >1 month decreased from 4 of 13 before the pockets were used to 1 of 25 with the intraperitoneal pockets (Fisher's exact test p = 0.038). Two hernia repairs were required after explantation when the biomaterial pocket was used. A decrease in return to surgery for bleeding was noted after the pocket was used (7/16 without the pocket and 3/32 with the pocket; Fisher's exact test, p = 0.010). Bleeding complications and pocket infections decreased in this early experience. Further study is necessary to confirm the apparent decrease in complication rate by using this new technique in this small cohort of patients.The Journal of Heart and Lung Transplantation 07/2003; 22(7):818-21. · 5.11 Impact Factor
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ABSTRACT: Our patient developed a wound infection that involved an implanted left ventricular assist device. At surgery, the pump was washed with a detergent-containing bacteriocidal solution, then antibiotic-impregnated polymethylmethacrylate beads were placed around the pump. The wound was revised using rectus muscle to cover the pump. The incisions have healed and the patient is now at home. She is on no systemic antibiotics and has no evidence of infection 11 months postoperatively.The Annals of Thoracic Surgery 10/1999; 68(3):1080-2. · 3.45 Impact Factor