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Long Term Analysis of Flap Coverage of Exposed Cardiac Ventricular Assist Devices
Nadeera Dawlagala MD, Vahe Fahradyan MD, Kihyun Cho MD, Antonio Rampazzo MD, Ph.D, Bahar Bassiri Gharb MD, Ph.D, James E. Zins, MD
Cleveland Clinic Department of Plastic Surgery
2017-02-15
Presenter: Nadeera Dawlagala, MD
Affidavit:
All the work on this project represents the original work of this resident
Director Name: Bahar Bassiri Gharb
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
A ventricular assist device (VAD) is implanted in patients awaiting heart transplant, or who require permanent ventricular support. An infected VAD limits lifespan and eligibility for transplant. Flaps may treat exposed or infected VADs by coverage and delivery of immune cells through its rich vasculature. We explore outcomes of flaps in infected VAD patients.
Methods
A retrospective chart review of infected VAD patients treated with flap from 1960-2016 at Cleveland Clinic main campus was conducted. Infection type, flap harvested, and survival outcomes were studied.
Results
Of 351 VAD patients, 10 flaps were used to treat nine infected VAD patients. Four of the nine also had exposed devices. There were seven males, and two females with an average age of VAD implant, and age of flap done at 55 ± 9.21, and 56.7±9.4 years. Seven patients received VADs for destination (permanent) therapy, and two were heart transplant candidates. The most common infection was MRSA (n=4), and sites included driveline (4), pump pocket (5), and sternal wound (6). Flaps were omentum (n=5), rectus abdominis (n=4), and pectoralis major (n=1). Seven of the nine patients expired, with a mean survival of 9.7±5.3 months after flap, and 19.9 months ±13.7 after initial VAD placement. Eight patients continued to battle a chronic VAD infection at time of death or last follow up, five of which expired from sepsis. The two potential heart transplant patients expired from sepsis prior to transplant.
Conclusion: Sepsis remained the leading cause of mortality in infected VAD patients despite flap.
