title: Multiple splenic infarctions due to septic embolization in a patient supported with Berlin Heart-EXCOR biventricular assist device.
abstract: Patients awaiting cardiac transplantation often require ventricular assist devices (VADs) due to instable circulatory condition. Device-related infections remain the 'Achilles heel' of mechanical circulatory support and wound complications after VAD placement are a formidable challenge to surgeons. Up to 25% of deaths in VAD patients are due to systemic sepsis, which occurs in 11-26% of patients and bacteria that are common pathogens including Staphylococcus, Pseudomonas, Enterococcus, and Candida. Sepsis, infection of implanted pump components, and infections of percutaneous drivelines continue to limit survival. The Berlin Heart-EXCOR VAD is a para-corporeal pulsatile system that has been successful in patients with severe biventricular dysfunction. We report a case of a 35-year-old male suffering from a postischemic cardiomyopathy who received an EXCOR biventricular assist device as a bridge to transplant. During the assistance the patient developed concomitant methicillin-resistant Staphylococcus aureus infection of implanted pump components which was resistant to conventional therapy. The patient developed sepsis with splenic infarctions due to septic embolization which was successfully treated with a heart transplant. In some extreme cases of VAD infections, such as this, the only therapeutic option is transplantation or device replacement.
authors.affiliation: Division of Cardiac Surgery, University of Turin, San Giovanni Battista Hospital, C.so Bramante 88, 10127 Turin, Italy. matteoatti@libero.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Attisani
authors.forename: Paolo
authors.initials: P
authors.lastname: Centofanti
authors.forename: Michele
authors.initials: M
authors.lastname: La Torre
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000628:therapy*; D003646:Debridement; D004617:Embolism / Q000382:microbiology* / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000628:therapy; D018805:Sepsis / Q000382:microbiology* / Q000628:therapy; D013156:Splenectomy; D013159:Splenic Infarction / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents