Anesthesia in Patient with Left Ventricular Assist Device Support. A Case Report.
AJTES Vol 4, No 2, July 2020
PDF Full Text

Keywords

LVAD
transplantation
infections
heart failure
resistant bacteria

How to Cite

KUCI, S., IBRAHIMI, A., LIKAJ, E., GOGA, M., BEJKO, E., LLAZO, S., & ZEITANI, J. (2020). Anesthesia in Patient with Left Ventricular Assist Device Support. A Case Report. Albanian Journal of Trauma and Emergency Surgery, 4(2), 716-719. https://doi.org/10.32391/ajtes.v4i2.112

Abstract

Background; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms.

Case presentation; A 48-year-old patient 72 kg, height 172 cm with dilated cardiomyopathy, his course was complicated by pump failure requiring LVAD HeartMate III placement 3 years (Milan Italy). The parameters of the LVAD pump were determined for the patient from the moment of the Pump speed 5300 rpm Flow 4.4 lpm was set. The patient performed moderate activity under normal conditions. The patient regularly took Coumadin to keep the recommended INR levels at the recommended target values ​​2.5. At the site of the exit of the cavity from the skin in the region of the right hypochondrium, there was an infection that for a long time was treated with various schemes with ambulatory antibiotics

Conclusions; In the present case we showed that successful eradication of a chronic LVAD driveline infection was only possible when approached both surgically and conservatively. It is important to note that a good knowledge of the physiopathology of heart failure, the widest possible information on the treatment of heart failure with the help of LVAD implantation is very important in the treatment and survival of these patients.

https://doi.org/10.32391/ajtes.v4i2.112
PDF Full Text

References

Starling RC, Naka Y, Boyle AJ, et al. Results of the post-U.S. Food and Drug Administration- approval study with a continuous-flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechani- cally Assisted Circulatory Support). J Am Coll Cardiol 2011; 57: 1890–8.

John R, Kamdar F, Liao K, Colvin-Adams M, Boyle A, Joyce L. Improved survival and decreasing incidence of adverse events with the HeartMate II left ventricular assist device as bridge-to-transplant therapy. Ann Thorac Surg 2008;86:1227–34, discussion 1234–5.

John R, Naka Y, Smedira NG, et al. Continuous flow left ventricular assist device outcomes in commercial use compared with the prior clinical trial. Ann Thorac Surg 2011; 92: 1406–13, discussion 1413.

Cowger J, Sundareswaran K, Rogers JG, et al. Predicting survival in patients receiving contin- uous flow left ventricular assist devices: the HeartMate II risk score. J Am Coll Cardiol 2013;61: 313–21.

Schaffer JM, Allen JG, Weiss ES, et al. Evalua- tion of risk indices in continuous-flow left ven- tricular assist device patients. Ann Thorac Surg 2009;88:1889–96.

Crow S, John R, Boyle A, et al. Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices. J Thorac Cardiovasc Surg 2009;137:208–15.

Morgan JA, Paone G, Nemeh HW, et al. Gastrointestinal bleeding with the HeartMate II left ventricular assist device. J Heart Lung Trans- plant 2012;31:715–8.

Harvey L, Holley CT, John R. Gastrointestinal bleed after left ventricular assist device implan- tation: incidence, management, and prevention. Ann Cardiothorac Surg 2014;3:475–9.

Mehra MR, Stewart GC, Uber PA. The vexing problem of thrombosis in long-term mechanical circulatory support. J Heart Lung Transplant 2014; 33:1–11.

Yuan N, Arnaoutakis GJ, George TJ, et al. The spectrum of complications following left ventric- ular assist device placement. J Card Surg 2012;27: 630–8.

Takeda K, Naka Y, Yang JA, et al. Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion. J Heart Lung Transplant 2014;33:141–8.

Nienaber JJ, Kusne S, Riaz T, et al. Clinical manifestations and management of left ventricu- lar assist device-associated infections. Clin Infect Dis 2013;57:1438–48.

Crow S, Chen D, Milano C, et al. Acquired von Willebrand syndrome in continuous-flow ventric- ular assist device recipients. Ann Thorac Surg 2010;90:1263–9, discussion 1269.

Baghai M, Heilmann C, Beyersdorf F, et al. Platelet dysfunction and acquired von Willebrand syndrome in patients with left ventricular assist devices. Eur J Cardiothorac Surg 2015;48:421–7.

Hasin T, Deo S, Maleszewski JJ, et al. The role of medical management for acute intravascular hemolysis in patients supported on axial flow LVAD. ASAIO J 2014;60:9–14.

Slaughter MS, Sobieski MA 2nd, Graham JD, Pappas PS, Tatooles AJ, Koenig SC. Platelet acti- vation in heart failure patients supported by the HeartMate II ventricular assist device. Int J Artif Organs 2011;34:461–8.

Meyer AL, Malehsa D, Bara C, et al. Acquired von Willebrand syndrome in patients with an axial flow left ventricular assist device. Circ Heart Fail 2010;3:675–81.

Schmitto JD, Hanke JS, Rojas SV, Avsar M, Haverich A. First implantation in man of a new magnetically levitated left ventricular assist device (HeartMate III). J Heart Lung Transplant 2015;34:858–60.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.