ACCF/AHA/HFSA 2011 Survey Results: Current Staffing Profile of Heart Failure Programs, Including Programs That Perform Heart Transplant and Mechanical Circulatory Support Device Implantation

2011 ◽  
Vol 17 (5) ◽  
pp. 349-358 ◽  
Author(s):  
Mariell Jessup ◽  
Nancy M. Albert ◽  
David E. Lanfear ◽  
JoAnn Lindenfeld ◽  
Barry M. Massie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Device Implantation ◽  
Support Device ◽  
Survey Results ◽  
Mechanical Circulatory Support Device ◽  
Circulatory Support Device

scholarly journals 174. Temporizing Surgical Measures for Deep Mechanical Circulatory Support Device Infections: Case Series Report

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S110-S110
Author(s):  
Armita Kabirpour ◽  
Daniel G Tang ◽  
Oveimar De laCruz
Keyword(s):  
Heart Transplant ◽  
Mechanical Circulatory Support ◽  
Klebsiella Oxytoca ◽  
Case Series ◽  
Circulatory Support ◽  
Bridge To Transplant ◽  
Surgical Measures ◽  
Support Device ◽  
Mechanical Circulatory Support Device ◽  
Circulatory Support Device

Abstract Background Durable mechanical circulatory support device (MCSD) use continues to grow. MCSD deep-seated infections are a serious complication. Removal of the infected hardware is not always possible. Methods Single institution retrospective review of all culture-proven deep MCSD infection (pump and/or driveline) from 2009–2019. Patients were managed with intravenous (IV) and oral (PO) antibiotics; definitive surgical interventions included incision and drainage (I&D), device replacement, and heart transplant; and temporizing surgical measures were chronic chest tube (CCT) drainage for pump pocket and mediastinum and antibiotic impregnated bead implantation for driveline infection. Outcomes were analyzed. Results Total of 29 patients identified, 23 (79%) were male. Median age at device implantation was 44 years (20–68). MCSD were 18 (62%) destination therapy and 11 (38%) bridge to transplant. MCSD included 1 Heartmate I, 17 Heartmate II, 1 Heartmate III, 4 Heartware HVAD, and 6 Syncardia TAH. The median time to infection of 258 days (43–1551), affecting pump in 8 (28%), pump + driveline in 13 (44%), and driveline in 8 (28%). Microorganisms were S. aureus in 17 (60%, MRSA 11 and MSSA 6); coag-negative staphylococci in 3 (10%); Viridans streptococci in 1; Serratia marcescens in 3; P. aeruginosa in 2; Klebsiella oxytoca in 1; Mycobacterium abscessus in 1 and C. albicans in 1. Antibiotics are given to 28 patients, 23 (80%) with initial IV for a median of 6 weeks (1–14) and 5 (17%) with initial PO, for a median of 7 weeks (2–20). Nineteen patients (83%) on IV received PO antibiotics after. 17 patients (61%) remained on chronic suppression antibiotics (13 PO, 2 IV, 2 PO and IV). Twenty-six (90%) patients had I&D, 6 (21%) had device replacement and 11 (38%) had transplant. Of 21 patients with pump infection 16 (76%) had CCT drainage of pump pocket site or mediastinum for a median of 116 days (range 10–887 days). Of 21 patients with driveline infections, 6 (29%) had antibiotic impregnated bead implants. Overall survival at 90 days was 28/29 (95%) and 24/29 (83%) at 1 year. Infection-related mortality in Table 1. Conclusion Deep MCSD infection remains a challenging clinical problem. CCT drainage (for pump) and antibiotic-impregnated bead implant (for driveline) may be temporizing options for patients unable to undergo timely device replacement or heart transplant. Disclosures All authors: No reported disclosures.

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