Successful bridge to transplant in a highly sensitized patient with a complicated pump pocket infection.
A 32-year-old man with doxorubicin-induced cardiomyopathy presented in cardiogenic shock. He underwent placement of a Novacor (WorldHeart, Inc., Oakland, CA) left ventricular assist device as a bridge to transplant. Post-operatively he developed a pump pocket infection and dehiscence of his abdominal wound with exposure of the pump. This was treated with irrigation and drainage, antibiotic bead placement and flap closure. Both pre- and post-operative panel-reactive antibodies (PRA) were elevated. He underwent desensitization with intravenous immune globulin (IVIg), rituximab, mycophenolate mofetil and pre-operative plasmapheresis. A donor heart was identified and found to be acceptable by virtual crossmatch. He was transplanted and is doing well with normal graft function at >1 year post-operatively.
McGee
Edwin C
EC
Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, 201 East Huron Street, Galter 11-140, Chicago, IL 60611, USA. emcgee@nmh.org
Cotts
William
W
Tambur
Anat R
AR
Friedewald
John
J
Kim
John
J
O'Connell
John
J
Wallace
Suzanne
S
McCarthy
Patrick M
PM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy; D009202:Cardiomyopathies / Q000139:chemically induced / Q000601:surgery*; D004317:Doxorubicin / Q000009:adverse effects; D004322:Drainage; D016027:Heart Transplantation / Q000276:immunology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000188:drug therapy; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D007507:Therapeutic Irrigation; D065227:Transfusion Reaction; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin