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Left Ventricular Assist Device and the Ongoing Saga of Driveline Infections: A Case Report of Salvage with Omental Flap
Shoichiro A. Tanaka, MD
Christopher Babycos, MD
Summa Health System, Akron, OH
2020-02-15
Presenter: Shoichiro A. Tanaka, MD
Affidavit:
I certify that this project represents the original work of the resident.
Director Name: Douglas Wagner, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Heart failure affects many people, and many require left ventricular assist device (LVAD) placement as a bridge to heart transplant or as destination therapy. When these devices become infected, it is a challenge to eradicate the infection, with failure resulting in significant morbidity and mortality. This challenge increases tremendously when a soft tissue deficit is created after radical debridement.
Case
A 45-year old woman underwent placement of an LVAD device for post-partum cardiomyopathy. Her history was complicated by bleeding dyscrasia, history of sleeve gastrectomy, prior infections necessitating LVAD exchanges and prior rectus abdominis muscle flap for coverage. She presented with new-onset fever, malaise, and drainage from a prior midline abdominal wound. Computerized tomography demonstrated a large fluid collection around the LVAD driveline. Radical debridement was performed to achieve source control, leaving an exposed driveline within a soft-tissue deficit measuring 10 x 13 x 4 cm. She underwent open harvest of the omental flap which allowed adequate, durable soft tissue coverage. A negative pressure wound device was placed and the patient underwent split thickness skin grafting four days later for definitive coverage. The patient improved significantly and was discharged home with long-term intravenous antibiotics.
Conclusion
Early, aggressive debridement is paramount to successful treatment of LVAD infections. Use of an omental flap offers excellent soft tissue coverage while providing an improved vascular and immunogenic environment for healing.
