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driveline infection

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 INTERMACs registry from April 2008 to December 2012 formed this cohort. Outcomes were compared to HMII Bridge to Transplant (BTT) and Destination Therapy (DT) Post-Approval Studies...
August 22, 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
James Fitzgibbon, Nicholas E Kman, Diane Gorgas
BACKGROUND: Left ventricular assist devices (LVADs) are a viable treatment option for patients with end-stage heart failure. LVADs can improve survival, quality of life, and functional status. The indications for LVAD placement to support left ventricular function are temporary support, a bridge to transplantation, or destination therapy. CASE REPORT: A 61-year-old man with past medical history significant for advanced congestive heart failure from ischemic cardiomyopathy, status post LVAD (HeartMate II; Thoratec Corporation, Pleasanton, CA) placement 2009 as destination therapy, presented to the Emergency Department (ED) with implantable cardiac defibrillators firing four times that morning...
March 2016: Journal of Emergency Medicine
Michele Gallo, Giacomo Bortolussi, Jonida Bejko, Vincenzo Tarzia, Gino Gerosa, Tomaso Bottio
The Jarvik 2000 is a left ventricular assist device (LVAD) used as either a bridge-to-transplant or destination therapy with the possibility of retroauricular percutaneous power delivery (pedestal). Percutaneous driveline infection in LVAD is a life-threatening complication that affects both the quality and length of life in patients. With its rigid fixation to the bone, the pedestal and the vascularity of scalp skin promote healing and reduce the risk of driveline infection. We describe a technique to remove the skull-mounted percutaneous pedestal of the Jarvik 2000 after heart transplantation...
January 2016: International Journal of Artificial Organs
Paolo Brenner, Thomas J Wirth, Anja Liebermann, Maks Mihalj, Sonja Güthoff, Christian Hagl, Bruno Reichart
OBJECTIVES: Organ shortages and increased numbers of nontransplant older patients have necessitated a search for alternatives to heart transplants. The Jarvik 2000 assist device (Jarvik Heart, Inc., Manhattan, NY, USA), as a small long-term axial flow pump, offers many advantages, such as retroauricular power supply, which minimizes driveline infection risks. When implanted biventricularly, the device may offer support for patients with biventricular heart failure, especially for nontransplant patients as a destination therapy...
April 2016: Experimental and Clinical Transplantation
Marat Fudim, Christopher L Brown, Mary E Davis, Monica Djunaidi, Matthew R Danter, Frank E Harrell, John M Stulak, Nicholas A Haglund, Simon Maltais
Driveline infections (DLI) are a cause of morbidity after continuous-flow left ventricular assist device (CF-LVAD) implantation. Because driveline trauma contributes to DLI, we assessed whether intraoperative placement of a temporary external anchoring suture (EAS) influenced DLI rate. We analyzed 161 consecutive patients with CF-LVAD (HMII 82; HW 79) implantation. Two groups were defined: placement of EAS (n = 85) or No EAS (n = 76). For NO EAS patients, the driveline was permanently anchored internally to the rectus fascia...
May 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Anne-Marie Leuck
Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, but infection remains a substantial risk. LVAD driveline infections (DLIs) are the most common type of LVAD-associated infection (LVADI). In the past several years we have expanded our understanding of DLI epidemiology, standardized the definition of LVADIs, improved infection rates through changes in implantation techniques, and investigated potential new modalities for DLI diagnosis. However, significant challenges remain for optimizing DLI prevention and treatment...
December 2015: Journal of Thoracic Disease
Elisabeth E Donahey, Derek M Polly, J David Vega, Marshall Lyon, Javed Butler, Duc Nguyen, Ann Pekarek, Kristin Wittersheim, Patrick Kilgo, Christopher A Paciullo
Left ventricular assist devices improve survival prospects in patients with end-stage heart failure; however, infection complicates up to 59% of implantation cases. How many of these infections are caused by multidrug-resistant organisms is unknown. We sought to identify the incidence, risk factors, and outcomes of multidrug-resistant organism infection in patients who have left ventricular assist devices. We retrospectively evaluated the incidence of multidrug-resistant organisms and the independent risk factors associated with them in 57 patients who had permanent left ventricular assist devices implanted at our institution from May 2007 through October 2011...
December 2015: Texas Heart Institute Journal
Bahadir Gultekin, Ozgur Ersoy, Murat Ozkan, Ilknur Akkaya, Sevi Umaroglu, Atilla Sezgin
OBJECTIVES: The number of patients with end-stage cardiac failure who are waiting for transplant has been increasing, although number of heart donations stays limited. This has resulted in an increased use of left ventricular assist devices. Here, we present results of patients who received left ventricular assist device implants at Baskent University Ankara Hospital. MATERIALS AND METHODS: We retrospectively evaluated 24 patients who received a HeartWare left ventricular assist device (HeartWare Inc, Framingham, MA, USA) between April 2012 and February 2015; 2 patients (8...
November 2015: Experimental and Clinical Transplantation
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