Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Ann Thorac Surg. 2020 Oct;110(4):1302-1307. doi: 10.1016/j.athoracsur.2020.02.007. Epub 2020 Mar 10.
Relapsed ventricular assist device-specific infections are associated with high morbidity, mortality, and hospital costs. A new combination of cold atmospheric plasma and special dressing technique with negative pressure wound therapy with an additional underlay of carbon cloth and hypochlorite rinsing solutions has been developed and reported in this study.
Between January 2016 and January 2018, 9 patients with relapsed infected driveline or pump pocket infection were treated with this new combined strategy. The primary endpoint was complete wound healing without recurrence of infection, defined as the presence at the same site within the first year after treatment. The secondary endpoint was control of infection, defined as a marked reduction of the infected area.
After a median treatment time of 3 weeks, an immediate response was observed in all patients, and complete healing was achieved in 6 patients. Five patients met the primary endpoint, and infection did not recur after a median follow-up of 17.5 (range, 12.1 to 21.8) months. One patient underwent heart transplantation 6 months after successful wound treatment (complete wound healing). The remaining 3 patients were discharged with controlled infection. After a median follow-up of 5.7 months, 1 destination therapy patient died at home, and 2 patients underwent urgent heart transplantation because of recurrence of infection caused by Pseudomonas aeruginosa. Side effects were not observed.
The new combination treatment offers a promising option for patients with ventricular assist device-relapsed infection. Despite this, further studies are warranted to confirm those encouraging preliminary results.
复发的心室辅助装置相关感染与高发病率、死亡率和医院费用相关。本研究中开发并报告了一种新的组合策略，即采用冷大气压等离子体和特殊敷料技术联合负压伤口治疗，并在下面添加碳纤维布和次氯酸盐冲洗溶液。
2016 年 1 月至 2018 年 1 月，9 例复发的感染性驱动线或泵囊感染患者接受了这种新的联合治疗策略。主要终点是无感染复发的完全伤口愈合，定义为治疗后 1 年内同一部位的存在。次要终点是感染的控制，定义为感染区域的显著减少。
中位治疗时间为 3 周后，所有患者均立即出现反应，6 例患者达到完全愈合。5 例患者达到主要终点，在中位随访 17.5 个月（范围为 12.1 至 21.8 个月）后感染未复发。1 例患者在成功治疗伤口后 6 个月接受了心脏移植（完全愈合）。其余 3 例患者因感染控制出院。中位随访 5.7 个月后，1 例接受心脏移植的患者在家中死亡，2 例因铜绿假单胞菌引起的感染复发而紧急接受心脏移植。未观察到副作用。
新的联合治疗为心室辅助装置复发感染的患者提供了一种有希望的选择。尽管如此，仍需要进一步的研究来证实这些令人鼓舞的初步结果。
