Kimura Mitsutoshi, Nishimura Takashi, Kinoshita Osamu, Okada Shuichi, Inafuku Hitoshi, Kyo Shunei, Ono Minoru
Department of Therapeutic Strategy for Heart Failure, The University of Tokyo.
Ann Thorac Cardiovasc Surg. 2014;20 Suppl:842-5. doi: 10.5761/atcs.cr.12.02192. Epub 2013 Mar 26.
A 52-year-old man suffering from dilated cardiomyopathy underwent implantable left ventricular assist device (LVAD) insertion as a bridge to transplantation. He presented with evidence of LVAD-related mediastinitis and pump pocket infection 57 days after the LVAD implantation. The mediastinum was reopened and irrigated. A large amount of pus was observed around the outflow and inflow conduits and in the pump pocket. Negative pressure wound therapy (NPWT) was initiated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood and mediastinal pus. Enterobacter cloacae was also isolated by mediastinal pus culture after the beginning of the NPWT. Three weeks after the start of the NPWT, the pus culture became negative, and omental transposition and sternal closure were performed. Intravenous antibiotics were administered until day 42, with the treatment subsequently switched to oral antibiotics. He was discharged from the hospital on day 57 and followed up at the outpatient clinic. Our findings suggest that NPWT followed by omental transposition be useful to treat mediastinitis or pump pocket infection after implantable LVAD insertion.
一名52岁的扩张型心肌病男性患者接受了植入式左心室辅助装置（LVAD）植入术，作为移植的过渡治疗。LVAD植入术后57天，他出现了与LVAD相关的纵隔炎和泵袋感染的迹象。重新打开纵隔并进行冲洗。在流出道和流入道导管周围以及泵袋中观察到大量脓液。开始进行负压伤口治疗（NPWT）。从血液和纵隔脓液中分离出耐甲氧西林金黄色葡萄球菌（MRSA）。在开始NPWT后，纵隔脓液培养还分离出阴沟肠杆菌。NPWT开始三周后，脓液培养转阴，进行了大网膜移位和胸骨闭合术。静脉注射抗生素直至第42天，随后改为口服抗生素。他于第57天出院，并在门诊进行随访。我们的研究结果表明，NPWT后进行大网膜移位有助于治疗植入LVAD后的纵隔炎或泵袋感染。
