title: Salvage of infected left ventricular assist device with antibiotic beads.
abstract: BACKGROUND
  The use of left ventricular assist devices has become common for the treatment of end-stage heart failure, both as a bridge to transplantation and as destination therapy. The nature of these devices and the comorbid conditions of the patients in whom the devices are implanted lead to high rates of device infection that are related directly to mortality.
  
  
  METHODS
  Over 2 years, the senior author (S.A.I.) treated 26 patients with left ventricular assist device infections, ranging from superficial driveline infections to deeper pocket infections and device infections. An algorithm involving the use of repeated débridement and placement of antibiotic beads was used in treatment of these infections. Once cleared of infection, patients were treated with definitive closure or flap coverage of the formerly infected device component.
  
  
  RESULTS
  Seventeen of 26 patients with left ventricular assist device-related infections were cleared of their infection using this method. Ten of these patients underwent flap coverage of the device after their infection was cleared. In patients that were cleared of infection, mortality was 29 percent, whereas patients with recalcitrant infections had a mortality of 67 percent over the course of the study.
  
  
  CONCLUSIONS
  A systematic approach to treating left ventricular assist device-related infections has the potential to treat and clear these infections, with promising overall survival rates. This proposed algorithm led to high infection clearance rates compared with previously published literature. Infection clearance in patients on left ventricular assist device destination therapy may result in mortality rates approaching those of their uninfected peers.
authors.affiliation: Houston, Texas From the Divisions of Plastic Surgery and Cardiothoracic Surgery, Baylor College of Medicine; and the Texas Heart Institute.
authors.forename: James D
authors.initials: JD
authors.lastname: Kretlow
authors.forename: Rodger H
authors.initials: RH
authors.lastname: Brown
authors.forename: Erik M
authors.initials: EM
authors.lastname: Wolfswinkel
authors.forename: Amy S
authors.initials: AS
authors.lastname: Xue
authors.forename: Larry H
authors.initials: LH
authors.lastname: Hollier
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ho
authors.forename: Hari R
authors.initials: HR
authors.lastname: Mallidi
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.forename: Shayan A
authors.initials: SA
authors.lastname: Izaddoost
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003646:Debridement; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents