Management of Deep Device Related Infection in Patient Implanted with Mechanical Cardiac Support Device Using V.A.C. System

Česká verzia

Authors: D. Turek; I. Netuka; J. Malý; O. Szárszoi; J. Bešík; M. Urban; J. Pirk; V. Petkov ^*
Authors place of work: Klinika Kardiovaskulární chirurgie IKEM Praha, přednosta: prof. MUDr. Jan Pirk, DrSc. ; Oddělení klinické mikrobiologie IKEM Praha, vedoucí: MUDr. Vladimír Petkov ^*
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 12, s. 693-696.
Category: Monothematic special - Original

Summary

Infection remains the most significant cause of morbidity and mortality in pacients implanted with mechanical circulatory support devices (MCSD), reaching prevalence of 40–60% according various authors [1, 2]. Successful treatment of the whole spectrum of infectious complications is the basic determinant in archieving good results in MCSD patients. The treatment involves standard surgical procedures, as well as the use of vacuum assisted closure (V.A.C.) therapy in the last few years. We demonstrate successful management of deep device related infection using V.A.C therapy in a patient with MCSD, giving him the opportunity to heart transplantation, and thereafter successful treatment of poststernotomy mediastinitis in this imunosupressed pacient after heart transplantation.

Key words:
mechanical circulatory support device (MCSD) – infection – Vacuum assisted closure system (V.A.C.) – heart transplantation – poststernotomy mediastinitis

Zdroje

1. Holman, W. L., Park, S. J., Long, J. W., et al. Infection in Permanent Circulatory Support: Experience From the REMATCH Trial. J. Heart Lung Transplant., 2004; 23: 1359–1365.

2. Holman, W. L., Rayburn, B. K., McGiffin, D. C., et al. Infection in Ventricular Assist Devices: Prevention and Treatment. Ann. Thorac. Surg., 2003; 75[Suppl]: S48–S57

3. Špinar, J., Hradec, J., Meluzín, J., et al. Doporučení pro diagnostiku a léčbu chronického srdečního selhání ČKS 2006. Cor. Vasa, 2007; 49(1): K5–K34, Supplementum Cor. Vasa, 2007; 49(11): 75–104.

4. Netuka, I., Malý, J., Szárszoi, O. Mechanické srdeční podpory v terapii terminálního srdečního selhání. Cor. Vasa, 2008; 50(5): 207–214.

5. Schulman, A. R., Martens, T. P., Russo, M. J., et al. Effect of left ventricular assist device infection on post-transplant outcomes. J. Heart Lung Transplant., 2009; 28: 237–242.

6. Itescu, S., John, R. Interactions between the recipient immune system and the left ventricular assist device surface: immunological and clinical implications. Ann. Thorac. Surg., 2003; 75: S58.

7. Raja, S. G., Berg, G. A. Should vacuum-assisted closure therapy be routinely used for management of deep sternal wound infection after cardiac surgery? Interact. CardioVasc. Thorac. Surg., 2007; 6: 523–527.

8. Holman, W. L., Pae, W. E., Teutenberg, J. J., et al. INTERMACS: Interval Analysis of Registry Data. J. Am. Coll. Surg., 2009; 208: 755–762.