Flap Coverage of Infected Ventricular Assist Devices Influences Patient Outcomes

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Wound Management

Background:

• Left ventricular assist devices (LVADs) are increasingly used for end-stage cardiac failure.
• LVAD-related infections pose a significant challenge to long-term device efficacy.
• Limited data exist on optimal management strategies for these infections post-debridement.

Purpose of the Study:

• To evaluate the effectiveness of different surgical closure techniques for LVAD-related infections.
• To compare short-term and long-term outcomes of primary closure, secondary intention, and flap reconstruction.
• To determine the impact of positive cultures on reoperation rates.

Main Methods:

• Retrospective analysis of 117 patients with LVAD infections undergoing operative debridement (2012-2022).
• Categorization of closure methods: primary closure, secondary intention (wound vac with grafting), and flap reconstruction.
• Review of patient demographics, infection details, coverage procedures, and 90-day/lifetime complications, including return to operating room (RTOR).

Main Results:

• Flap reconstruction and secondary intention showed significantly lower rates of lifetime RTOR for infection compared to primary closure (P=0.01, P=0.02).
• No significant difference in 90-day complications was observed among the closure groups (P=0.76, P=0.58).
• Positive cultures at definitive coverage did not significantly impact complication or RTOR rates.

Conclusions:

• Coverage of infected LVAD sites with flaps or via wound vac therapy decreases lifetime reoperations for infection.
• These methods do not increase 90-day complications.
• Positive cultures should not preclude these effective closure strategies if healthy granulation tissue is present.