Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
Center for Innovation and Outcomes Research, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2024 May;167(5):1824-1832.e2. doi: 10.1016/j.jtcvs.2022.09.020. Epub 2022 Sep 20.
Among left ventricular assist device patients, the most commonly infected component is the drive line, which can be managed with antibiotics and local debridement. Infection of intrathoracic device components is less common but more difficult to manage. Herein we describe the incidence of deep device infection (DDI) at our center as well as management and outcomes.
We retrospectively reviewed 658 patients who underwent implantable left ventricular assist device insertion with HeartMate 2 (Abbott) or HeartMate 3 (Abbott) devices between January 2004 and June 2021. DDI was defined according to radiographic and clinical criteria. Cumulative incidence was calculated using a Fine-Gray subdistribution model; survival analysis was performed using the method of Kaplan and Meier.
There were 32 (4.8%) DDIs during this study period. Drive line infection and re-exploration for bleeding were associated with development of DDI. Cumulative incidence of DDI increased over time, affecting 11% (7%-18%) at 5 years. The dominant microbes involved in DDI were Pseudomonas aeruginosa (19%) and methicillin-resistant Staphylococcus aureus (13%). Nineteen patients (59%) with device infection underwent device exchange, 6 (19%) underwent initial transplant, and 7 (22%) were treated solely with debridement and antibiotics. Of those who underwent device exchange, 12 (63%) developed reinfection of their new device and 6 underwent subsequent heart transplant. Patients who underwent transplantation for management of device infection had improved 5-year survival (80% vs 11%; P = .01) but 3 patients (25%) developed deep sternal wound infection after transplant.
DDI is a rare but challenging complication in this destination era. Heart transplantation is the preferred management strategy for eligible patients but infectious complication is common.
在左心室辅助装置患者中，最常感染的部件是驱动线，可通过抗生素和局部清创来治疗。胸内装置部件的感染较少见，但更难处理。本文描述了我们中心深部器械感染（DDI）的发生率以及处理方法和结果。
我们回顾性分析了 2004 年 1 月至 2021 年 6 月期间植入 HeartMate 2（雅培）或 HeartMate 3（雅培）左心室辅助装置的 658 例患者。根据影像学和临床标准定义 DDI。使用 Fine-Gray 亚分布模型计算累积发生率；使用 Kaplan-Meier 方法进行生存分析。
在研究期间，有 32 例（4.8%）发生 DDI。驱动线感染和再探查出血与 DDI 的发生有关。DDI 的累积发生率随时间增加，5 年内发生率为 11%（7%-18%）。DDI 中涉及的主要微生物是铜绿假单胞菌（19%）和耐甲氧西林金黄色葡萄球菌（13%）。19 例（59%）感染设备的患者进行了设备更换，6 例（19%）进行了初始移植，7 例（22%）仅接受清创和抗生素治疗。在进行设备更换的患者中，12 例（63%）新设备再次感染，6 例随后进行了心脏移植。接受移植治疗设备感染的患者 5 年生存率提高（80%比 11%；P=0.01），但 3 例（25%）在移植后发生深部胸骨伤口感染。
在这个靶器官时代，DDI 是一种罕见但具有挑战性的并发症。心脏移植是符合条件患者的首选治疗策略，但感染并发症很常见。
