PURPOSE:
Plastic surgeons in tertiary care centers or in conjunction with high-volume cardiac surgery programs will increasingly be asked to consult on patients with Left Ventricular Assist Devices (LVADs). These are being used with increasing frequency as “bridge” therapy to cardiac transplant and as “destination” treatment for those not considered candidates for transplantation. Particularly relevant in the latter group, site infections of the LVAD device and, commonly, the “drive line” have prompted consultation for salvage of these colonized or infected prostheses. Our purpose is to present the technology and indications for LVAD placement; to review the common complications which arise, prompting plastic surgery consultation; and to describe several operations for salvage, including a review of our results.
METHOD:
LVAD placement in cardiac failure patients began at our institution in 2004. Consultation to our division in cases of LVAD infection has become commonplace since early 2007. We reviewed the medical records of all patients operated on for LVAD infection from 2007 to present.
RESULTS:
Six patients received a total of 9 operations. Procedures performed included local incision and drainage, negative pressure dressing application, adjacent tissue rearrangement, omental flap, and rectus abdominus flap. All patients survived initial operation. Complications included wound dehiscence of drive line exit site, recurrent infection and need for LVAD removal due to persistent bacteremia. There were two late mortalities. Salvage was defined as resolution of the wound or infection to allow the natural course of their disease to prevail. Overall salvage rate was 75%, though frequently multiple procedures were required.
CONCLUSION:
Plastic surgeons entering practice in institutions with advanced cardiac surgical services will increasingly be asked to evaluate end-stage patients with LVADs for salvage of infected devices. This can be accomplished via the methods described. Omental and rectus abdominus flaps yielded more frequent salvage than local flaps or simple incision and drainage.