Nurozler F, Argenziano M, Oz M C, Naka Y
Department of Surgery, College of Physicians & Surgeons of Columbia University, New York, New York, USA.
Ann Thorac Surg. 2001 Feb;71(2):614-8. doi: 10.1016/s0003-4975(00)01444-2.
Infection remains as the most serious complication and represents a significant threat to patients during long-term mechanical circulatory support. Fungal infection is a particularly worrisome complication and left ventricular assist device (LVAD) endocarditis does pose a serious threat.
One hundred and sixty-five patients underwent TCI Heartmate LVAD implantation between July 1991 and December 1999 at our institution. Detailed medical records were kept prospectively for all patients, and a variety of infection-related endpoints were analyzed on patients with fungal LVAD endocarditis.
Thirty-seven patients (22%) developed fungal infections during LVAD support. Five (3%) of those met our criteria for the diagnosis of fungal LVAD endocarditis. Microbial portals of entry were identifiable in all cases. Infections were managed successfully in 4 patients (80%).
The successful management of fungal LVAD endocarditis currently requires early recognition of potentially nonspecific signs and symptoms, and timely institution of antifungal therapy. In some cases with device-specific manifestations of LVAD endocarditis, device removal and replacement is necessary. In patients with clinical manifestations of sepsis and fungal driveline site or pocket infections without positive blood culture, urgent transplantation may be the appropriate management. In the setting of shortage in the donor supply, device removal and replacement is necessary.
感染仍然是最严重的并发症，对接受长期机械循环支持的患者构成重大威胁。真菌感染是一种特别令人担忧的并发症，左心室辅助装置（LVAD）心内膜炎确实构成严重威胁。
1991年7月至1999年12月期间，165例患者在本机构接受了TCI Heartmate LVAD植入术。前瞻性地保存了所有患者的详细病历，并对患有真菌性LVAD心内膜炎的患者分析了各种与感染相关的终点指标。
37例患者（22%）在LVAD支持期间发生真菌感染。其中5例（3%）符合我们对真菌性LVAD心内膜炎的诊断标准。所有病例均能确定微生物的侵入途径。4例患者（80%）感染得到成功控制。
目前，成功治疗真菌性LVAD心内膜炎需要早期识别潜在的非特异性体征和症状，并及时进行抗真菌治疗。在某些具有LVAD心内膜炎特定装置表现的病例中，有必要取出并更换装置。对于有脓毒症临床表现以及真菌性驱动线部位或囊袋感染但血培养阴性的患者，紧急移植可能是合适的治疗方法。在供体供应短缺的情况下，有必要取出并更换装置。
