Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return...

Area of Science:

• Cardiovascular Surgery
• Infectious Disease Management
• Reconstructive Surgery

Background:

• Left ventricular assist devices (LVADs) are crucial for end-stage heart failure patients awaiting transplantation.
• LVAD-related infections pose significant challenges to long-term device efficacy and patient outcomes.
• Previous studies suggest flap coverage can decrease lifetime return to operating room (RTOR) after infection washout.

Purpose of the Study:

• To evaluate the impact of early plastic and reconstructive surgery (PRS) intervention on outcomes for patients with LVAD infections.
• To determine if PRS involvement influences length of stay, 90-day complications, and lifetime RTOR.
• To compare outcomes between PRS closure and cardiothoracic surgery (CTS) closure for infected LVADs.

Main Methods:

• Retrospective review of 104 patients with LVAD infections from 2008-2021 at a single institution.
• Analysis of patient demographics, infection onset, device coverage type, timing of coverage, and post-coverage complications.
• Comparison of outcomes between PRS (n=53) and CTS (n=51) closure using statistical tests (χ2, ANOVA).

Main Results:

• PRS closure was associated with decreased lifetime RTOR (P=0.03) and fewer 90-day infectious complications (P=0.007) compared to CTS closure.
• No significant difference in average hospital discharge day (postoperative day 7) between PRS and CTS groups.
• Increased incidence of diabetes in the PRS group; increased postoperative hematoma risk in PRS patients (P=0.046).

Conclusions:

• Plastic and reconstructive surgery involvement in managing infected LVAD devices leads to improved long-term outcomes.
• PRS intervention is linked to reduced lifetime return to the operating room and fewer 90-day infectious complications.
• Earlier PRS consultation for infected LVAD coverage may offer additional patient benefits.