Management of Left Ventricular Assist Device Infection With Heart Transplantation

Prendergast, Thomas; Todd, Barbara; Beyer, Antje; Furukawa, Satoshi; Eisen, Howard J.; Addonizio, V. Paul; Browne, Barry J.; Jeevanandam, Valluvan

doi:10.1016/s0003-4975(97)00286-5

Cited by 51 publications

(30 citation statements)

References 7 publications

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“…P ! .05 However, many other reports did not find an influence of infection on overall survival [12,31,32]. In all these studies, infection did not preclude heart transplantation or alter the survival rate after transplantation [12,[30][31][32].…”

Section: Discussionmentioning

confidence: 99%

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Nosocomial Infections Occurring during Receipt of Circulatory Support with the Paracorporeal Ventricular Assist System

Mekontso-Dessap¹,

Kirsch

Vermès

et al. 2002

CLIN INFECT DIS

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This retrospective study sought to report the spectrum of infections in a homogenous group of 39 patients who underwent implantation of the Thoratec paracorporeal ventricular assist device system (Thoratec Laboratories) in an emergency setting. Thirty-one of the 39 patients developed a total of 99 nosocomial infections (attack rate, 79.5%; incidence, 4.9 per 100 support-days). The lungs were the most frequently involved site (31.3%), and coagulase-negative Staphylococcus species were the pathogens most frequently isolated (16.2%). Infected patients required more transfusions and chest surgical revisions, as well as a longer duration of mechanical ventilation and a longer stay in the intensive care unit, compared with uninfected patients. Cox regression analysis revealed that chest surgical revision was the only independent risk factor for infection at any site (odds ratio, 2.6; 95% confidence interval, 1.2-5.7). There was no significant effect of infection on heart transplantation rate and overall survival.

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Section: Discussionmentioning

confidence: 99%

“…In all these studies, infection did not preclude heart transplantation or alter the survival rate after transplantation [12,[30][31][32]. In addition, there was no statistically significant difference between infected and uninfected VAD recipients regarding complications of infection that occur after transplantation [31,32].…”

Section: Discussionmentioning

confidence: 99%

Nosocomial Infections Occurring during Receipt of Circulatory Support with the Paracorporeal Ventricular Assist System

Mekontso-Dessap¹,

Kirsch

Vermès

et al. 2002

CLIN INFECT DIS

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“…La infección del dispositivo ocurre en 18% de los pacientes, en estos casos, a pesar del retiro de éste y dar terapia antibiótica adecuada, el pronóstico es sombrío 30,33 .…”

Section: Infeccionesunclassified

Estado actual de los sistemas de soporte circulatorio mecánico: State of the art

2006

Rev. méd. Chile

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Circulatory mechanical support. State of the artDespite advances in medical treatment, the prognosis of advanced heart failure remains poor. The number of hospitalizations for heart failure exacerbations continues to increase and most patients will ultimately die of complications related to heart failure. Implantable left ventricular assist devices (LVAD) are currently in use throughout the world with increasing frequency. This paper is a comprehensive review about mechanical support, focusing on a general description of the differents LVAD, complications and mortality (Rev Méd Chile 2006; 134: 1330-37 a insuficiencia cardíaca (IC) es una de las principales causas de mortalidad y hospitalización, se estima que su prevalencia se incrementará con el envejecimiento de la población. Pese al avance en la terapia farmacológica, el trasplante es una alternativa probada, pero restringida por la disponibilidad de donantes, observándose una elevada mortalidad en lista de espera de alrededor de 16% al año 1 . A lo anterior se suma el que en casos de IC aguda, muchas veces no se logra el trasplante dado lo crítico de la situación o a contraindicaciones. Es por estos motivos que los sistemas de soporte circulatorio mecánico (SSCM) han crecido en importancia, primordialmente como puente al trasplante, para lograr recuperación de una IC aguda, y en forma preliminar como terapia definitiva. Nuestro centro inició, a mediados de 2003, un programa de soporte circulatorio de corto plazo (ABIOMED BVS 5000). Este sistema ha sido utilizado en 4 pacientes, logrando el trasplante en tres de ellos. Esta experiencia inicial nos motivó a revisar el estado actual de los SSCM. CRITERIOS DE SELECCIÓN DE PACIENTESPARA ASISTENCIA VENTRICULAR Estos dispositivos son utilizados en pacientes con IC grave refractaria a terapia habitual y que no han tenido respuesta al uso del balón de contrapulsación (BCIA) y drogas vasoactivas (DVA). En general, se utilizan criterios similares a los usados para el ingreso a lista de trasplante cardíaco de urgencia. La presencia de disfunción hepática o renal, determinada por la IC y que potencialmente es reversible, no contraindica su uso. Del punto de vista hemodinámico, se utilizan valores referenciales para plantear el uso de SSCM como un índice cardíaco de 2 L/min/m 2 , presión arterial sistólica <90 mmHg y con capilares pulmonares mayores de 20 mmHg. INDICACIONES DEL USO DE SOPORTE VENTRICULAR1. Shock cardiogénico postcardiotomía: La necesidad de soporte circulatorio postcirugía cardíaca es relativamente baja (0,2 a 1%) 2 . Es más frecuente en cirugías de revascularización coronaria con disfunción ventricular significativa. El objetivo es

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“…The use of ventricular assist devices prior to transplantation can often result in infectious complications [4]. The presence of specific pathogens in the donor or recipient is also known to put the allograft recipient at risk for increased morbidity or mortality.…”

Section: Introductionmentioning

confidence: 99%

Cardiac transplantation: Pre-transplant infectious diseases evaluation and post-transplant prophylaxis

Keay

2002

Curr Infect Dis Rep

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Screening of recipients and donors of cardiac allografts for infectious pathogens, and the use of appropriate immunization and antimicrobial prophylaxis strategies, remain important for the control of infection following heart transplantation. However, the risk of infectious complications in a particular patient must often be weighed against the risk of delaying or denying allograft transplantation. In addition, the ongoing degree of immunosuppression and its contribution to the risk for infectious complications should also be considered to guide the length of prophylactic antimicrobial therapy and provide optimal patient care.

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Management of Left Ventricular Assist Device Infection With Heart Transplantation

Cited by 51 publications

References 7 publications

Nosocomial Infections Occurring during Receipt of Circulatory Support with the Paracorporeal Ventricular Assist System

Nosocomial Infections Occurring during Receipt of Circulatory Support with the Paracorporeal Ventricular Assist System

Estado actual de los sistemas de soporte circulatorio mecánico: State of the art

Cardiac transplantation: Pre-transplant infectious diseases evaluation and post-transplant prophylaxis

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