<< Back to the abstract archive
Routine Use of Negative Pressure Wound Therapy and Flap Reconstruction Improves Salvage of Threatened Ventricular Assist Devices: A Meta-analysis Study of Patient Outcomes
Robert C. Clark, BS; Marco Swanson, MD; Yida Cai, BS; Alison Jin, BA; Kyle Lineberry, MD; Anand Kumar, MD, FACS, FAAP
Case Western Reserve University School of Medicine - University Hospitals Department of Plastic and
2021-02-01
Presenter: Robert Clark
Affidavit:
100% of this project is the original work of the presenting medical student and his cited colleagues.
Director Name: Anand Kumar
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Significance:
Infected Ventricular Assist Device (VAD)-associated wounds are common and associated with significant morbidity and mortality. The efficacy of hardware salvage utilizing flaps and negative pressure wound therapy (NPWT) remains understudied. We hypothesized patients treated with flaps and/or NPWT would have higher hardware salvage rates compared with other surgical management strategies.
Methods:
A meta-analysis study evaluating VAD-associated wounds was performed following PRISMA guidelines. Primary predictor variables were flap-reconstruction (FR), NPWT, no flap-reconstruction (NFR), and infection location (mediastinum vs. driveline). Primary outcomes were hardware retention (salvage) vs. explantation, infection recurrence, or death. Twenty-five studies were included. Standard statistical methods (SPSS 27) included logistic regression analysis.
Results:
70 patients with nonsignificant demographic differences between cohorts were identified. Overall salvage was 58% in both driveline and mediastinum cohorts with no difference in salvage between location of infection (p>.999). Overall, NPWT significantly improved salvage compared to no NPWT [78.6% vs. 45.2% respectively (p=.007)] and FR significantly improved salvage compared to NFR [69.4% vs. 33.3% respectively (p=.008)].
Logistic regression analysis predicting odds of salvage by flap (area under curve = 0.6560) was significantly four times higher (95% CI: 1.5 – 13.5) and predicting the odds for salvage by NPWT (area under curve = 0.6648) was also significantly four times higher (95% CI: 1.5 – 13.2) compared to no treatment.
Conclusions:
NPWT or flap reconstruction for treatment of threatened VAD hardware was associated with a significantly improved device salvage compared to other surgical strategies. Further study will focus on subgroup analysis of flaps utilized and synergistic treatment benefits.
