title: Successful treatment of pump pocket infection after left ventricular assist device implantation by negative pressure wound therapy and omental transposition.
abstract: A 52-year-old man suffering from dilated cardiomyopathy underwent implantable left ventricular assist device (LVAD) insertion as a bridge to transplantation. He presented with evidence of LVAD-related mediastinitis and pump pocket infection 57 days after the LVAD implantation. The mediastinum was reopened and irrigated. A large amount of pus was observed around the outflow and inflow conduits and in the pump pocket. Negative pressure wound therapy (NPWT) was initiated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood and mediastinal pus. Enterobacter cloacae was also isolated by mediastinal pus culture after the beginning of the NPWT. Three weeks after the start of the NPWT, the pus culture became negative, and omental transposition and sternal closure were performed. Intravenous antibiotics were administered until day 42, with the treatment subsequently switched to oral antibiotics. He was discharged from the hospital on day 57 and followed up at the outpatient clinic. Our findings suggest that NPWT followed by omental transposition be useful to treat mediastinitis or pump pocket infection after implantable LVAD insertion.
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, The University of Tokyo.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Kimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Shuichi
authors.initials: S
authors.lastname: Okada
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Inafuku
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000150:complications; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D009852:Omentum / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000900:Anti-Bacterial Agents