Salvage of Infected Left Ventricular Assist Device with Antibiotic Beads

Kretlow, James D.; Brown, Rebecca M.; Wolfswinkel, Erik M.; Xue, Amy S.; Hollier, Larry H.; Ho, Jonathan K.; Mallidi, Hari R.; Gregorič, Igor D.; Frazier, O.H.; Izaddoost, Shayan A.

doi:10.1097/01.prs.0000436837.03819.3f

Cited by 47 publications

(71 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One method is to resect infected tissue and cover the driveline with well-perfused tissue such as rectus muscle. Additional tools may include the use of antimicrobial beads, 23 wound vacuums, and novel therapies such as Mepilex™ or Aquacel ® dressing changes. If all of these fail, another measure to combat prolonged infection is to move the driveline into the intraperitoneal space, wherein a completely new exit site is created and the driveline covered with omentum.…”

Section: Treatmentmentioning

confidence: 99%

A Review of Infections in Patients with Left Ventricular Assist Devices: Prevention, Diagnosis and Management

Trachtenberg¹,

Cordero‐Reyes²,

Elias³

et al. 2015

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

Section: Treatmentmentioning

confidence: 99%

A Review of Infections in Patients with Left Ventricular Assist Devices: Prevention, Diagnosis and Management

Trachtenberg¹,

Cordero‐Reyes²,

Elias³

et al. 2015

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

“…5D, E) required local tissue coverage and rectus abdominis muscle flaps where soft tissue coverage was warranted. 5 …”

Section: Left Ventricular Assist Device Salvagementioning

confidence: 99%

“…The cause of mortality in all those with persisting infections was sepsis, whereas the cause in those with cleared infections included cerebrovascular accident, right heart failure, left ventricular assist device-related gastrointestinal perforation, and graft rejection. 5 Antibiotic-impregnated beads have been successfully used in the treatment of prosthetic-related infections by orthopedic and vascular surgeons with reported clearance rates ranging from 60% to 100% with recurrence rates ranging from 0 to 20%. 22,[27][28][29][30][31] The beads are capable of delivering high concentrations of necessary antibiotics directly to a site of infection, thereby reducing the systemic side effects.…”

Section: Left Ventricular Assist Device Salvagementioning

confidence: 99%

“…This was possibly due to the decreased efficacy of the fibrin sealant and calcium sulfate compared with polymethylmethacrylate; however, this may also have been due to the challenge of treating multidrugresistant organisms. 5 Repeated debridement and bead exchange typically performed every 1 to 2 weeks until surgical site cultures were negative or until other definitive endpoints had been reached (device removal, transplant, or if the patient expired). Subsequently, the device was permanently covered with a vascularized flap using a myocutaneous, fasciocutaneous, and/or omental flap.…”

Section: Left Ventricular Assist Device Salvagementioning

confidence: 99%

“…4 Infections pose a severe burden on patients, lead to significant health care costs and lengthy hospital stays, and may also lead to mortality. 5 When compared with noninfectious cardiac device complications, pacemaker infections result in an 8.4-to 11.6-fold increase in mortality rates along with a mean hospitalization cost ranging from $31,149 to $55,003. 6 Although both pacemakers and LVADs are implantable cardiac devices, their infection profile and treatment differ significantly due to the size of the device and the need for an external power source for the LVAD.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Infected Cardiac Implantable Electronic Devices

Fakhro

Jalalabadi

Brown

et al. 2016

Seminars in Plastic Surgery

View full text Add to dashboard Cite

Since their earliest application, cardiac implantable electronic devices (CIEDs), such as pacemakers, implantable defibrillators, and left ventricular assist devices (LVADs), have proven beneficial in the prevention of fatal cardiac-related disorders. 1 The past 50 years have seen a sharp rise in cardiac implantable device use with a resultant decline in deaths from ischemic, myocardial, and cardiac rhythm causes. 2 As the indications and guidelines governing CIED use broaden, so too does their widespread employment. 3 The rate of CIED infections has mirrored their increased use with some studies suggesting that the rate of device infections has overshadowed their implantation rate. 4 Infections pose a severe burden on patients, lead to significant health care costs and lengthy hospital stays, and may also lead to mortality. 5 When compared with noninfectious cardiac device complications, pacemaker infections result in an 8.4-to 11.6-fold increase in mortality rates along with a mean hospitalization cost ranging from $31,149 to $55,003. 6 Although both pacemakers and LVADs are implantable cardiac devices, their infection profile and treatment differ significantly due to the size of the device and the need for an external power source for the LVAD. However, both demonstrate a wide range of infection rates, with the true incidence of infection remaining elusive. 7 Topkara et al report a pacemaker infection rate of between 13% and 80%; however, others estimate it to be between 2% and 4% with rates rising 124% between years 1990 to 1999 and a 57% rise from 2004 to 2006, respectively. 8,9 Similarly, infection rates related to LVAD placement demonstrate a large range of between 13% and 80% among recipients. 10 This wide variability in infection risk is in part due to different types of infections that have been included under the category of CIED-related infections. Various reports broadly included patients with surgical site infections, postoperative pneumonia, central venous catheter-related sepsis, and nosocomial urinary tract infections, in addition to infection of the CIED. 10 Various comorbidities may contribute to CIED infections. Patients of advanced age, with congestive heart failure, with a metastatic malignancy, on corticosteroid therapy, or with renal failure are more likely to develop CIED infections thereby increasing their mortality. 9 Device Infection Diagnosis PacemakersThe diagnosis of pacemaker infections is often challenging. Pocket site infections are diagnosed clinically, often presenting with inflammatory skin changes including pain, swelling, AbstractWith their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to...

show abstract