title: Successful left ventricular assist device re-implantation with omental covering for MDRP device infection.
abstract: We present a case of paracorporeal left ventricular assist device (p-LVAD)-related infection, caused by multi-drug resistant Pseudomonas aeruginosae (MDRP), and successfully treated by p-LVAD re-implantation with omental covering. A 59-year-old man underwent p-LVAD implantation and coronary artery bypass grafting after percutaneous cardiopulmonary support and intra-aortic balloon pumping for cardiogenic shock due to acute myocardial infarction. Then, he was registered for heart transplantation. He suffered from blood stream infection causative organism of Pseudomonas aeruginosa, 2 months after that operation. He underwent re-median sternotomy and open drainage, 15 months after the p-LVAD implantation. However, he suffered from septic shock due to MDRP. He underwent p-LVAD re-implantation under hypothermic circulatory arrest and iodine gauze packing, followed by omental covering of the all artificial materials in his body 10 days after that operation. Soon after that, the infection was well controlled and the intravenous antibiotics could be discontinued 2 months after that operation. He successfully underwent heart transplantation, 17 months after that procedure. We concluded that p-LVAD re-implantation with omental covering is seemed to be useful in the treatment of massive device infection. This procedure might be a novel treatment for severe VAD-related infection until heart transplantation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, 207, Nishihara, 903-0215, Okinawa, Japan. hitoshiinafuku@yahoo.co.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Inafuku
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, 207, Nishihara, 903-0215, Okinawa, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kuniyoshi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, 207, Nishihara, 903-0215, Okinawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashiro
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, 207, Nishihara, 903-0215, Okinawa, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Totsuka
authors.affiliation: Department of Cardiac Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyou-ku, 113-8655, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D018432:Drug Resistance, Multiple; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009852:Omentum / Q000637:transplantation; D019919:Prosthesis Implantation; D011552:Pseudomonas Infections / Q000209:etiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012086:Reoperation; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
keywords: Bridge to transplantation; Multi-drug resistant Pseudomonas aeruginosae; Omentum; Paracorporeal left ventricular assist device