OJOTS  Vol.4 No.2 , May 2014
Attention to Details Reduces Infection Rates in Patients with Continuous Flow Pumps
Abstract: The increased use of mechanical circulatory support has led to a rise in infectious complications in the recent years predisposing this population of patients to higher morbidity and mortality. In this study, we report a significantly lower rate of driveline infections of 0.12 episodes/patient-year as compared to the rates reported in the existing literature in patients with the HMII (Heartmate II). The study is limited by the fact that it is based on a small population of patients and was conducted retrospectively making recall bias hard to rule out. It is strictly restricted to one type of continuous flow pump (HMII) solely to decrease variations in the data reviewed. The exact cause of the low infection rate noted in this study is difficult to define. However, detailed teaching to the caregivers and the patient as well as close follow-ups in the perioperative period may substantially contribute to the outcome noted. Continued research limited to similar continuous flow ventricular assist devices in larger study populations would shed light on defining causes of infections in this population and developing robust algorithms to prevent such complications.
Cite this paper: Nair, N. , Gongora, E. , Sareyyupoglu, B. , Collier, I. , Alvarado, S. , Nasar, A. and Zehr, K. (2014) Attention to Details Reduces Infection Rates in Patients with Continuous Flow Pumps. Open Journal of Organ Transplant Surgery, 4, 15-22. doi: 10.4236/ojots.2014.42003.

[1]   DeBakey, M.E. (1971) Left Ventricular Bypass Pump for Cardiac Assistance. American Journal of Cardiololgy, 27, 3-11.

[2]   Portner, P., Oyer, P. and McGregor, C. (1985) First Human Use of an Electrically Powered Implantable Ventricular Assist System. Artificial Organs, 9, 36.

[3]   Kirklinand, J.K. and Naftel, D.C. (2008) Mechanical Circulatory Support: Registering a Therapy in Evolution. Circulation: Heart Failure, 1, 200-205.

[4]   Hannan, M.M., Husain, S., Mattner, F., et al., (2011) Working Formulation for the Standardization of Definitions of Infections in Patients Using Ventricular Assist Devices. The Journal of Heart and Lung Transplantion, 30, 375-384.

[5]   Gordon, R.J., Quagliarello, B. and Lowy, F.D. (2006) Ventricular Assist Device-Related Infections. The Lancet Infectious Disease, 6, 426-437.

[6]   Baddour, L.K., Bettmann, M.A., Bolger, A.F., et al. (2003) Nonvalvular Cardiovascular Device-Related Infections. Circulation, 108, 2015-2031.

[7]   Gordon, R.J., Weinberg, A.D., Pagani, F.D., et al. (2013) Prospective, Multicenter Study of Ventricular Assist Device Infections. Circulation, 127, 691-702.

[8]   Grossi, P., DallaGasperina, D., Pagani, F., Marone, P., Vigano, M. and Minoli, L. (2001) Infectious Complications in Patients with the Novacor Left Ventricular Assist System. Transplantation Proceeding, 33, 1969-1971.

[9]   Malani, P.N., Dyke, D.B.S., Pagani, F.D. and Chenoweth, C.E. (2002) Nosocomial Infections in Left Ventricular Assist Device Recipients. Clinical Infectious Diseases, 34, 1295-1300.

[10]   Sinha, P., Chen, J.M., Flannery, M., Scully, B.E., Oz, M.C. and Edwards, N.M. (2000) Infections during Left Ventricular Assist Device Support Do Not Affect Posttransplant Outcomes. Circulation, 102, III194-III199.

[11]   Topkara, V.K., Kondareddy, S., Malik, F., et al. (2010) Infectious Complications in Patients with Left Ventricular Assist Device: Etiology and Outcomes in the Continuous-Flow Era. The Annals of Thoracic Surgery, 90, 1270-1277.

[12]   Deng, M.C., Loebe, M., El-Banayosy, A., et al. (2001) Mechanical Circulatory Support for Advanced Heart Failure: Effect of Patient Selection on Outcome. Circulation, 103, 231-237.

[13]   Goldstein, D.J., el-Amir, N.G., Ashton Jr., R.C., et al. (1995) Fungal Infections in Left Ventricular Assist Device Recipients: Incidence, Prophylaxis, and Treatment. ASAIO Journal, 41, 873-875.

[14]   Starling, R.C., Naka, Y., Boyle, A.J., et al. (2011) Results of the Post-US Food and Drug Administration-Approval Study with a Continuous Flow Left Ventricular Assist Device as a Bridge to Heart Transplantation: A Prospective Study Using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Journal of the American College of Cardiology, 57, 1890-1898.

[15]   Nienaber, J.J., Kusne, S., Riaz, T., et al. (2013) Clinical Manifestations and Management of Left Ventricular Assist Device-Associated Infections. Clinical Infectious Diseases, 57, 1438-1448.

[16]   Bomholt, T., Moser, C., Sander, K., et al. (2011) Driveline Infections in Patients Supported with a Heartmate II: Incidence, Aetiology and Outcome. Scandinavian Cardiovascular Journal, 45, 273-278.

[17]   Loforte, A., Montalto, A., Ranocchi, F., et al. (2009) HeartmateII Axial-Flow Left Ventricular Assist System: Management, Clinical Review and Personal Experience. Journal of Cardiovascular Medicine (Hagerstown), 10, 765-771.

[18]   John, R., Kamdar, F., Eckman, P., et al. (2011) Lessons Learned from Experience with over 100 Consecutive HeartMateII Left Ventricular Assist Devices. The Annals of Thoracic Surgery, 92, 1593-1599.

[19]   Gordon, R.J., Weinberg, A.D., Pagani, F.D., et al. (2013) Prospective, Multicenter Study of Ventricular Assist Device Infections. Circulation, 127, 691-702.

[20]   Abicht, T., Gordon, R., Meehan, K., Stosor, V., McCarthy, P. and McGee Jr., E. (2013) Complex Heartmate II Infection Treated with Pump Exchange to Heart Ware HVAD. ASAIO Journal, 59, 88-192.