Postmortem microbiological findings of two total artificial heart recipients
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J J Dobbins1, G S Johnson, C M Kunin
1Beliamine College, Louisville, KY 40205.
Abstract:
This report describes the postmortem microbiological findings and related gross pathology from two patients who had the longest survival after implantation of the Jarvik-7-100 total artificial heart. We documented extensive polymicrobial colonization at the site of the device and adjacent structures; however, the internal drive lines were remarkably free of bacterial colonization despite evidence of infection at the skin junction and in close proximity to the artificial heart. The polyurethane polymer (Biomer) on the external surface of the device was discolored and pitted in appearance and the Velcro material that attaches the two ventricles together was eroded. A nonspecific mass of tissue that was adherent to the device and to portions of the drive lines contained inflammatory cells, fibrinous debris, and colonies of microorganisms.
Insights
Postmortem analysis of the Jarvik-7-100 total artificial heart revealed extensive polymicrobial colonization near the device, but not in internal drive lines. Material degradation and tissue adhesion were observed, indicating device-related complications.
Area of Science:
- Biomedical Engineering
- Infectious Diseases
- Pathology
Background:
- The Jarvik-7-100 total artificial heart (TAH) represents a significant advancement in mechanical circulatory support.
- Long-term survival with TAH implants presents unique challenges, including device-related complications and infection risks.
Observation:
- Postmortem examination of two long-term Jarvik-7-100 TAH recipients revealed gross pathological findings.
- Extensive polymicrobial colonization was noted at the device site and adjacent tissues.
- The external polyurethane (Biomer) surface showed discoloration and pitting; Velcro material was eroded.
Findings:
- Internal drive lines were largely free of bacterial colonization, contrasting with infections at the skin junction.
- A non-specific tissue mass adherent to the device and drive lines contained inflammatory cells and microorganisms.
- Microbiological findings correlated with observed gross pathology.
Implications:
- Understanding device material degradation and infection patterns is crucial for improving TAH longevity and patient outcomes.
- These findings highlight the need for improved strategies in managing infections associated with long-term mechanical circulatory support devices.
- Further research into biocompatible materials and infection prevention is warranted for future artificial heart designs.