Thrombus with infection in total artificial heart animals

From January 1980 to December 1990, several types of total artificial hearts were implanted into 378 animals. In a retrospective study of these animals, 147 (39%) were found to have thrombus with infection (T&I). The criteria for diagnosis was thrombus formation in the artificial heart and a positive blood culture. The most common pathogen isolated from T&I animals was Pseudomonas species. Concurrent skin lesions and contamination from the pressure lines may be the primary sources of infection, but bacterial translocation from the intestine is another possible route. The main pathological findings at necropsies of artificial heart animals with T&I were associated with sepsis, congestive heart failure, infected thrombus, thromboembolism, and multiple organ infarctions. Most thrombi appeared to have originated from valve junctions and connectors. On the basis of these observations, a possible mechanism for pathogenesis of T&I has been proposed. The results suggest that design improvements and surface modifications to reduce thrombosis are important factors that should be carefully considered. Similarly, it is important to eliminate the route of entry of pathogenic microorganisms. These findings imply that bacterial interaction with thrombus, device related bacterial colonization, and host immunomodulation and gut barrier function following artificial heart implantation need further investigation.