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Infectious complications in four long-term recipients of the Jarvik-7 artificial heart
C M Kunin1, J J Dobbins, J C Melo
1Department of Medicine, Ohio State University, Columbus 43210.
Insights
Infectious complications, particularly periprosthetic infections from drive lines, significantly limited long-term use of the Jarvik-7 artificial heart. Intensive antibiotic treatment led to resistant bacteria and Clostridium difficile overgrowth.
Area of Science:
- Medicine
- Infectious Diseases
- Biomedical Engineering
Background:
- The Jarvik-7 artificial heart represents a significant advancement in mechanical circulatory support.
- Long-term recipients of artificial hearts face unique challenges, including infectious complications.
Observation:
- Four long-term Jarvik-7 recipients experienced significant infectious complications.
- Drive line infections spread to the mediastinal periprosthetic space, becoming a major limiting factor.
Findings:
- Periprosthetic infections were caused by various bacteria, including Staphylococcus species and Pseudomonas aeruginosa.
- Other complications included pneumonia, empyema, urinary tract infections, and Candida sepsis.
- Prolonged antimicrobial therapy suppressed but did not eradicate infections, leading to multiresistant strains and Clostridium difficile-associated diarrhea.
Implications:
- The current Jarvik-7 device is best suited for short-term use (<30 days) in critical patients.
- Managing infectious complications is crucial for improving outcomes in artificial heart recipients.
- Further research is needed to mitigate infectious risks associated with long-term mechanical circulatory support.
Abstract:
This article describes the infectious complications that occurred among four of the longest-term recipients of the Jarvik-7 artificial heart. Infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. Periprosthetic infections were due to coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and other Pseudomonas species. Other infectious complications incurred by some of the patients included pneumonia, empyema, urinary tract infection, and intravascular line sepsis with Candida. Intensive antimicrobial therapy for prolonged periods seemed to suppress but not to eradicate infection and was accompanied by the appearance of multiresistant bacterial strains. Complications of antimicrobial therapy included diarrhea secondary to overgrowth with Clostridium difficile in two patients. Use of the current device for more than 30 days should be considered extraordinary and should be reserved for patients for whom no other form of life support is available.