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driveline infection

Asad F Shaikh, Susan M Joseph, Brian Lima, Shelley A Hall, Rajasekhar Malyala, Aldo E Rafael, Gonzalo V Gonzalez-Stawinski, Themistokles Chamogeorgakis
Background Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange. Materials and Methods We retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution...
November 30, 2016: Thoracic and Cardiovascular Surgeon
Ann B Nguyen, Nir Uriel, Sirtaz Adatya
Mechanical circulatory support has revolutionized the treatment of heart failure, affording patients significantly improved survival and quality of life. However, further advancements in this technology have been hindered by adverse events, particularly gastrointestinal bleeding, driveline infection, stroke, and device thrombosis. Recently, there has been a renewed focus on device thrombosis as the reported incidence has increased. This review focuses on an update on the diagnostic modalities and current treatment algorithms of this serious complication...
November 22, 2016: Current Heart Failure Reports
Carrie K Gomez, Scott R Schiffman, Susan K Hobbs
OBJECTIVE: The purpose of this study is to identify early computed tomography findings around the driveline which would predict mediastinal or left ventricular assist device (LVAD) pocket abscess formation. MATERIALS AND METHODS: A retrospective analysis was performed on 128 LVAD recipients between January 2007 and December 2011. Infectious complications were subdivided into those affecting the driveline and those resulting in abscess formation either around the LVAD pump or mediastinum...
2016: Journal of Clinical Imaging Science
Stephan M Ensminger, Gino Gerosa, Jan F Gummert, Volkmar Falk
Because the first generation of pulsatile-flow devices was primarily used to bridge the sickest patients to transplantation (bridge-to-transplant therapy), the current generation of continuous-flow ventricular assist devices qualifies for destination therapy for patients with advanced heart failure who are ineligible for transplantation. The first-generation devices were associated with frequent adverse events, limited mechanical durability, and patient discomfort due device size. In contrast, second-generation continuous-flow devices are smaller, more quiet, and durable, thus resulting in less complications and significantly improved survival rates...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Farhan Zafar, Chet R Villa, David L Morales, Elizabeth D Blume, David N Rosenthal, James K Kirklin, Angela Lorts
OBJECTIVES: This study investigated how small patient size affects clinical outcomes in patients implanted with a continuous flow left ventricular assist device (CFLVAD). BACKGROUND: The development of smaller CFLVADs has allowed ventricular assist device (VAD) use in anatomically smaller patients; however, limited outcome data exist regarding CFLVAD use in patients with a body surface area (BSA) ≤1.5 m(2). METHODS: All CFLVAD patients entered in the Interagency Registry for Mechanically Assisted Circulatory Support registry April 2008 to September 2013 and with BSA data were included...
October 27, 2016: JACC. Heart Failure
Yuriy Pya, Makhabbat Bekbossynova, Saltanat Jetybayeva, Serik Bekbossynov, Saltanat Andossova, Roman Salov, Assel Medressova, Svetlana Novikova, Muradym Murzagaliyev
AIMS: The need for the left ventricular assist devices (LVAD) in patients with end-stage heart failure is well established, but prior to 2011, this was not available to patients in Kazakhstan. We describe the development of the sole LVAD programme in the context of a nascent heart transplantation programme and clinical outcomes for the first three years. METHODS AND RESULTS: From November 2011 to November 2014, 146 patients underwent implantation of 152 VADs (approximately 50 devices implanted per year)...
March 2016: ESC Heart Failure
Marina Pieri, Anna Mara Scandroglio, Marcus Müller, Panagiotis Pergantis, Alexandra Kretzschmar, Friedrich Kaufmann, Volkmar Falk, Thomas Krabatsch, Georg Arlt, Evgenij Potapov, Marian Kukucka
BACKGROUND AND AIM OF THE STUDY: Driveline infections in patients with implantable left ventricular assist devices (VAD) carry increasing risk for pump infection, thromboembolic events, decreased quality of life, and increased hospitalization. We report our experience with a surgical technique for refractory driveline infections without mediastinitis consisting of translocation and wrapping of the driveline with greater omentum tissue. METHODS: We retrospectively reviewed data of VAD patients who underwent surgical treatment by translocation and wrapping with omentum for severe chronic driveline infection...
December 2016: Journal of Cardiac Surgery
Daniele Camboni, Matthaeus Zerdzitzki, Stephan Hirt, René Tandler, Michael Weyand, Christof Schmid
OBJECTIVES: A silicone interface at skin level of left ventricular assist device (LVAD) may reduce the risk of driveline (DL) exit site infections when compared with other materials (e.g. velour). The purpose of this study was to evaluate the rate of DL exit site infection according to the presence of silicone or velour at the exit site with the redesigned INCOR, facilitating the positioning of silicone at the exit site. METHODS: The rate of DL exit site infection and overall survival were compared between the two groups (silicone group, n = 16/velour group, n = 24) with 1-year follow-up postimplantation...
October 4, 2016: Interactive Cardiovascular and Thoracic Surgery
Matthew C Black, Erin M Schumer, Michael Rogers, Jaimin Trivedi, Mark S Slaughter
Advanced heart failure (HF) patients not meeting criteria for ventricular assist device or heart transplant with life-limiting symptoms are limited to medical and resynchronization therapy. The Sunshine Heart C-Pulse, based on intra-aortic balloon pump physiology, provides implantable, on-demand, extra-aortic counterpulsation, which reduces afterload and improves cardiac perfusion in New York Heart Association Class III and ambulatory Class IV HF. The C-Pulse reduces New York Heart Association Class, improves 6-min walk distances, inotrope requirements and HF symptom questionnaires...
September 2016: Future Cardiology
O N Tuncer, C Kemaloğlu, O Erbasan, I Gölbaşı, C Türkay, Ö Bayezid
INTRODUCTION: Donor organ shortage is still a problem for heart transplantation. Only 10% of patients in waiting list undergo heart transplantation. Over the last 5 years, 2 different continuous flow pumps, the HeartMate II and the HeartWare, have been successful clinically in the alternative treatment of patients with end-stage heart disease. METHODS: Fifty-five patients underwent left ventricular assist device implantation between 2011 and 2014. Patients were followed on pump support for complications and intraoperative outcomes...
July 2016: Transplantation Proceedings
Sangjin Lee, Jason N Katz, Ulrich P Jorde, Nader Moazami, Ranjit John, Kartik S Sundareswaran, David J Farrar, O H Frazier
There is insufficient data on patients with small body size to determine if this should be considered a risk factor for continuous-flow left ventricular assist device (CF-LVAD) support. We sought to evaluate survival outcomes, adverse events, and functional status of CF-LVAD patients with body surface area (BSA) <1.5 m in a large national registry. Adults with BSA < 1.5 m (n = 128) implanted with a HeartMate II (HMII)-LVAD from the Interagency Registry for Mechanically Assisted Circulatory Support registry from April 2008 to December 2012 formed this cohort...
November 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Teruhiko Imamura, Takahide Murasawa, Hironori Kawasaki, Koichi Kashiwa, Osamu Kinoshita, Kan Nawata, Minoru Ono
Although the survival rate for left ventricular assist device (LVAD) therapy has improved, device-related complications are an unpredictable threat to the patient's quality of life. We focused on driveline infection, and aimed to determine whether specific features of drivelines affect the frequency of infection. We enrolled patients who underwent LVAD implantation and were followed-up at our institute between 2007 and 2015. We counted the occurrences of driveline infection requiring any antibiotic therapy over a 2-year study period...
July 22, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Shun Tanaka, Kan Nawata, Hiroto Kitahara, Shuichi Yoshitake, Takahiro Matsuoka, Yoshifumi Itoda, Osamu Kinoshita, Mitsutoshi Kimura, Minoru Ono
We successfully controlled infection of a left ventricular assist device by performing pump exchange. A 53-year-old man was implanted with DuraHeart for ischemic cardiomyopathy as a bridge to transplantation. Two years later, he was hospitalized with the diagnosis of driveline infection. The blood cultures detected Pseudomonas aeruginosa. During the admission, he developed brain hemorrhage perhaps due to septic emboli. The chest computed tomography scan revealed a small defect inside the outflow graft of the DuraHeart, which was highly suspected of vegetation...
July 11, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Masatoshi Akiyama, Yukihiro Hayatsu, Ko Sakatsume, Hidenori Fujiwara, Takuya Shimizu, Daijirou Akamatsu, Risako Kakuta, Yoshiaki Gu, Mitsuo Kaku, Kiichiro Kumagai, Shunsuke Kawamoto, Hitoshi Goto, Noriaki Ohuchi, Yoshikatsu Saiki
Patients supported by mechanical circulatory support have to wait for longer periods for heart transplantation in Japan. Infective events are a major complication and influence survival. Here, we present the case of a patient with an implantable left ventricular assist device for 6 months who had the complication of ruptured infective common iliac aneurysm. Graft placement with an omental flap was successfully performed via the alternative surgical approach to avoid percutaneous driveline injury. In samples of aortic specimens, 16S ribosomal DNA gene analysis identified Helicobacter cinaedi...
July 5, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Minoru Ono, Yoshiki Sawa, Takeshi Nakatani, Ryuji Tominaga, Yoshiro Matsui, Kenji Yamazaki, Yoshikatsu Saiki, Hiroshi Niinami, Goro Matsumiya, Hirokuni Arai
BACKGROUND: The HeartMate II (HMII) continuous-flow LVAD was approved for Japanese health insurance coverage in April 2013 as a bridge to transplantation (BTT). We report on post-approval Japanese multicenter outcomes, and a comparison between patients with low and high body surface area (BSA). METHODS AND RESULTS: HMII LVAD was implanted in 104 consecutive patients at 15 Japanese centers between April 2013 and July 2014. Perioperative data were submitted to the Japanese Registry for Mechanically Assisted Circulatory Support...
August 25, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Lutz Hilker, Thomas von Woedtke, Klaus Dieter Weltmann, Hans-Georg Wollert
Percutaneous driveline infections (DI) are leading factors for morbidity and mortality in ventricular assist device (VAD) patients. In recent years, cold atmospheric plasma (CAP) has been safely and effectively used in clinical settings to treat topical infections. We describe the first use of CAP to treat a superficial DI. CAP was applied with the kinPen® MED plasma jet device (neoplas tools GmbH, Greifswald, Germany), in the treatment of a DI in a 66-year-old VAD patient in Klinikum Karlsburg, Germany. The patient received a daily application of CAP of 1 min for 12 days...
June 28, 2016: European Journal of Cardio-thoracic Surgery
Jennifer Robertson, Brit Long, Alex Koyfman
BACKGROUND: Heart failure is a common condition in the United States. When medical therapy fails, ventricular device (LVAD) therapy may be required. With increasing use of LVADs, emergency physicians should understand how to manage problems that may arise with these devices. OBJECTIVE: The objective of this review is to familiarize physicians with LVAD components and LVAD physiology, and discuss the evaluation and management of LVAD complications. DISCUSSION: The LVAD contains numerous components, but the most important include the pump, inflow and outflow cannulas, and driveline...
July 2016: American Journal of Emergency Medicine
Marcia Stahovich, Kartik S Sundareswaran, Sarah Fox, William Hallinan, Peggy Blood, Leway Chen, Salpy V Pamboukian, Raymond Chinn, David J Farrar, Francis D Pagani, Laura Blue
The percutaneous lead management kit (PLMK) was developed for the HeartMate 2 (HM2) left ventricular assist device (LVAD) to reduce trauma at the exit site and to maintain a clean environment. REduce Driveline Trauma through StabIlization and Exit Site ManagemenT (RESIST) was a multicenter, prospective, nonrandomized study designed to evaluate the feasibility of the PLMK for managing the HM2 driveline exit site. Fifty patients were enrolled at five sites at a median of 495 days post-HM2 implant; 92% (46 of 50) of patients used the PLMK for a minimum of 30 days...
May 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Marlene L Durand, Stephanie C Ennis, Joshua N Baker, Janice M Camuso, Kathleen M McEachern, Camille N Kotton, Gregory D Lewis, Jose P Garcia, Thomas E MacGillivray
This retrospective cohort study evaluated the effect of topical polymyxin-trimethoprim (poly) prophylaxis on the incidence of driveline infections (DLIs) in patients with continuous-flow left ventricular assist devices. All 84 cases implanted 2005-2014 with device support ≥30 days were reviewed; support ranged 1 m-5.2 yrs. Beginning 2008, poly was applied to the exit site with dressing changes. Sixty-five patients received poly (poly group) for duration of follow-up, 19 did not (no-poly); group baseline characteristics were similar...
April 21, 2016: Artificial Organs
Akira Sezai, Tetsuya Niino, Shunji Osaka, Hiroko Yaoita, Munehito Arimoto, Hiroaki Hata, Motomi Shiono
BACKGROUND: Infection of the percutaneous site of a ventricular assist device (VAD) is a challenging complication. We report our experience with crystal violet Solbase (Nihon University crystal violet method) for prevention of driveline or cannula infections in VAD patients. PATIENTS AND METHODS: The crystal violet method was used in 10 patients (prophylaxis in nine and treatment in one). Eight patients had an extracorporeal VAD (Nipro) and two had an implantable VAD (Heart Mate II)...
August 23, 2016: Annals of Thoracic and Cardiovascular Surgery
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