Inafuku Hitoshi, Kuniyoshi Yukio, Yamashiro Satoshi, Totsuka Yuichi, Ono Minoru
Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, 207, Nishihara, 903-0215, Okinawa, Japan.
Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyou-ku, 113-8655, Tokyo, Japan.
J Artif Organs. 2016 Jun;19(2):192-5. doi: 10.1007/s10047-015-0881-6. Epub 2016 Jan 6.
We present a case of paracorporeal left ventricular assist device (p-LVAD)-related infection, caused by multi-drug resistant Pseudomonas aeruginosae (MDRP), and successfully treated by p-LVAD re-implantation with omental covering. A 59-year-old man underwent p-LVAD implantation and coronary artery bypass grafting after percutaneous cardiopulmonary support and intra-aortic balloon pumping for cardiogenic shock due to acute myocardial infarction. Then, he was registered for heart transplantation. He suffered from blood stream infection causative organism of Pseudomonas aeruginosa, 2 months after that operation. He underwent re-median sternotomy and open drainage, 15 months after the p-LVAD implantation. However, he suffered from septic shock due to MDRP. He underwent p-LVAD re-implantation under hypothermic circulatory arrest and iodine gauze packing, followed by omental covering of the all artificial materials in his body 10 days after that operation. Soon after that, the infection was well controlled and the intravenous antibiotics could be discontinued 2 months after that operation. He successfully underwent heart transplantation, 17 months after that procedure. We concluded that p-LVAD re-implantation with omental covering is seemed to be useful in the treatment of massive device infection. This procedure might be a novel treatment for severe VAD-related infection until heart transplantation.
我们报告一例由多重耐药铜绿假单胞菌（MDRP）引起的体外左心室辅助装置（p-LVAD）相关感染，并通过带网膜覆盖的p-LVAD再植入成功治愈。一名59岁男性因急性心肌梗死导致心源性休克，在接受经皮心肺支持和主动脉内球囊反搏后，进行了p-LVAD植入和冠状动脉旁路移植术。之后，他登记等待心脏移植。术后2个月，他发生了由铜绿假单胞菌引起的血流感染。p-LVAD植入术后15个月，他接受了再次正中胸骨切开术和开放引流。然而，他因MDRP感染而发生感染性休克。他在低温循环停搏和碘纱布填塞下接受了p-LVAD再植入，术后10天对体内所有人工材料进行网膜覆盖。此后不久，感染得到良好控制，术后2个月可停用静脉抗生素。该手术17个月后，他成功接受了心脏移植。我们得出结论，带网膜覆盖的p-LVAD再植入似乎对治疗大规模装置感染有用。在心脏移植前，该手术可能是治疗严重VAD相关感染的一种新方法。
