Abstract
We report successful treatment of mediastinitis with rerouting of the outflow vascular prosthesis after bi-ventricular assist device (Bi-VAD) implantation. A 23 years-old male with fulminant myocarditis underwent VAD implantation. He required sternotomy three times. Mediastinitis developed after the third surgery, and negative pressure wound therapy (NPWT) with irrigation was applied. The infection was well controlled, but after 3 months of NPWT hemorrhage developed because of injury of the outflow vascular prosthesis in the anterior mediastinum. We rerouted the outflow vascular prosthesis to the descending aorta via the left thoracic cavity. After rerouting, artificial material was removed from the anterior mediastinum. The sternal wound healed completely after NPWT. Intractable mediastinitis after extra-corporeal VAD implantation may be treated with irrigation and NPWT, but there is a possibility of outflow graft injury. A sternal wound could be closed as a secondary healing process by rerouting the outflow vascular prosthesis.
References
Marggraf G, Splittgerber FH, Knox M, Reidemeister JC. Mediastinitis after cardiac surgery—epidemiology and current treatment. Eur J Surg Suppl. 1999;584:12–6.
Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R. Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg. 2006;30:898–905.
Kinoshita O, Nishimura T, Kawata M, Ando M, Kyo S, Ono M. Vacuum-assisted closure with Safetac technology for mediastinitis in patients with a ventricular assist device. J Artif Organs. 2010;13:126–8.
Petzina R, Hoffmann J, Navasardyan A, Malmsjö M, Stamm C, Unbehaun A, Hetzer R. Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment. Eur J Cardiothorac Surg. 2010;38:110–3.
Simon D, Fischer S, Grossman A, Downer C, Hota B, Heroux A, Trenholme G. Left ventricular assist device-related infection: treatment and outcome. Clin Infect Dis. 2005;40:1108–15.
Holman WL, Park SJ, Long JW, Weinberg A, Gupta L, Tierney AR, Adamson RM, Watson JD, Raines EP, Couper GS, Pagani FD, Burton NA, Miller LW, Naka Y; REMATCH Investigators. Infection in permanent circulatory support: experience from the REMATCH trial. J Heart Lung Transplant. 2004;1359–65.
Kawata M, Morota T, Takamoto S, Kubota H, Kitahori K. Non-anastomotic rupture in the guideline of a Dacron thoracic aortic graft. J Vasc Surg. 2005;42:573.
Kawata M, Takamoto S, Morota T, Ono M, Motomura N, Murakami A, Suematsu Y. Is the guideline the cause of structural failure in current polyester vascular prostheses? An experimental study. Artif Organs. 2005;29:820–5.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Kurihara, C., Nishimura, T., Kinoshita, O. et al. Successful treatment of mediastinitis after ventricular assist device implantation with rerouting of the outflow vascular prosthesis. J Artif Organs 14, 155–158 (2011). https://doi.org/10.1007/s10047-010-0550-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10047-010-0550-8