From the Departments of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka Fu, Japan.
Department of thoracic and cardiovascular surgery, Dokkyo Medical University Saitama Medical center, Saitama Ken, Japan.
ASAIO J. 2023 Dec 1;69(12):1056-1064. doi: 10.1097/MAT.0000000000002031. Epub 2023 Aug 7.
Few studies have focused on the clinical outcomes and risk factors of left ventricular assist device (LVAD) pump infection, and no standard treatment for LVAD pump infection has been established. Therefore, we used a therapeutic flowchart to manage LVAD pump infections. We retrospectively evaluated 220 patients who underwent continuous-flow LVAD implantation between January 2005 and March 2021 at Osaka University, Japan. First, we performed wound debridement, negative-pressure wound therapy, antibiotic treatment, and omental flap transposition. Subsequently, we administered conservative treatment, scheduled implantable LVAD exchange, or emergent removal of the implantable LVAD and exchange for extracorporeal LVAD or percutaneous LVAD (IMPELLA). Pump infections occurred in 32 patients. The survival rates of patients with pump infections during LVAD support were 93%, 74%, and 61% at 180 days, 1 year, and 2 years after LVAD pump infection, respectively. Fifteen patients underwent successful heart transplantation. Bridge-to-bridge surgery, preoperative use of venoarterial extracorporeal membrane oxygenation or percutaneous LVAD, high lactate dehydrogenase levels, and driveline infection were significantly associated with pump infection. Our study reveals that poor preoperative condition and driveline infection were significant risk factors for LVAD pump infection.
很少有研究关注左心室辅助装置（LVAD）泵感染的临床结果和危险因素，也没有确立 LVAD 泵感染的标准治疗方法。因此，我们使用治疗流程图来管理 LVAD 泵感染。我们回顾性评估了 2005 年 1 月至 2021 年 3 月在日本大阪大学接受连续血流 LVAD 植入的 220 例患者。首先，我们进行了伤口清创、负压伤口治疗、抗生素治疗和网膜瓣转移。随后，我们给予保守治疗、计划植入式 LVAD 更换或紧急移除植入式 LVAD 并更换为体外 LVAD 或经皮 LVAD（IMPELLA）。32 例患者发生泵感染。LVAD 支持期间发生泵感染的患者在 LVAD 泵感染后 180 天、1 年和 2 年的生存率分别为 93%、74%和 61%。15 例患者成功进行了心脏移植。桥接桥手术、术前使用静脉动脉体外膜氧合或经皮 LVAD、高乳酸脱氢酶水平和驱动线感染与泵感染显著相关。我们的研究表明，术前条件差和驱动线感染是 LVAD 泵感染的显著危险因素。
