Flap coverage for the treatment of exposed left ventricular assist device (LVAD) hardware and intractable LVAD infections.

BACKGROUND

Left ventricular assist devices (LVADs) have become useful adjuncts in the treatment of patients with end-stage heart failure. LVAD implantation is associated with a unique set of problems; one such problem is device infection. We report our experience with flap salvage of infected and/or exposed LVAD hardware.

METHODS

Between 2011 and 2016, 49 patients underwent LVAD implantation at our institution. Patients were then categorized by infectious status: systemic infection not directly involving the LVAD device, hardware infection responsive to antibiotics, and exposure of LVAD hardware or device infection refractory to antibiotics requiring debridement and flap coverage.

RESULTS

Approximately 50% of device-related infections resolved with either oral or intravenous antibiotics while the other 50% necessitated debridement and coverage with healthy tissue. In total, 12 patients (24%) developed a device-related infection ranging from superficial driveline cellulitis to purulent pocket infections. Seven patients (14%) required extensive debridement and/or flap coverage.

CONCLUSION

Early debridement and coverage of exposed hardware are crucial to successfully treating these LVAD infections.