Abstract
An operative modification in which the NIPRO left ventricular assist device (LVAD) cannulas are passed through the intraperitoneal cavity is performed as the first-choice standard technique in our institution. Eighteen consecutive patients who underwent NIPRO LVAD implantation as heart transplantation candidates were enrolled in this study. The cannulas were passed through the intraperitoneal cavity in 11 patients (Group IP) and the extraperitoneal space in 7 patients (Group EP). A device-related major infection was defined as bloodstream infection and/or abscess formation in the deep tissue space. Device-related major infection occurred in 6 patients in Group IP and in 6 patients in Group EP. Of these patients, 3 patients in Group IP and 5 patients in Group EP suffered from uncontrollable bloodstream infection and finally died of development into multiple organ failure and/or cerebrovascular accidents. The actuarial rates of freedom from device-related major infection at 6 months after LVAD implantation were 100 % in Group IP and 38 % in Group EP, respectively (p = 0.02). Moreover, the actuarial survival rates after the initial device-related major infection in Group IP could be significantly higher than in Group EP (83 and 67 % at 6 months, p = 0.03). We demonstrated that this operative modification can contribute to prevention of progression of superficial skin infection to critical infection and to extension of the survival duration after the initial device-related major infection.
Similar content being viewed by others
References
Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH. HeartMate II clinical investigators. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.
Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM 3rd, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH. HeartMate II investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51.
Kitamura S. Heart transplantation in Japan: a critical appraisal for the results and future prospects. Gen Thorac Cardiovasc Surg. 2012;60:639–44.
Yamakawa M, Kyo S, Yamakawa S, Ono M, Kinugawa K, Nishimura T. Destination therapy: the new gold standard treatment for heart failure patients with left ventricular assist devices. Gen Thorac Cardiovasc Surg. 2013;61:111–7.
Takatani S, Matsuda H, Hanatani A, Nojiri C, Yamazaki K, Motomura T, Ohuchi K, Sakamoto T, Yamane T. Mechanical circulatory support devices (MCSD) in Japan: current status and future directions. J Artif Organs. 2005;8:13–27.
Morita S. An old ventricular assist device still working for patients with end-stage heart failure in Japan. Circ J. 2011;75:53–4.
Tanoue Y, Tominaga R. The present situation and clinical topics of ventricular assist device in Japan. Fukuoka Acta Medica. 2012;103:191–8 (in Japanese).
Saito S, Matsumiya G, Sakaguchi T, Fujita T, Kuratani T, Ichikawa H, Sawa Y. Fifteen-year experience with Toyobo paracorporeal left ventricular assist system. J Artif Organs. 2009;12:27–34.
Sasaoka T, Kato TS, Komamura K, Takahashi A, Nakajima I, Oda N, Hanatani A, Mano A, Asakura M, Hashimura K, Niwaya K, Funatsu T, Kobayashi J, Kitamura S, Shishido T, Wada K, Miyata S, Nakatani T, Isobe M, Kitakaze M. Improved long-term performance of pulsatile extracorporeal left ventricular assist device. J Cardiol. 2010;56:220–8.
Shiga T, Kinugawa K, Hatano M, Yao A, Nishimura T, Endo M, Kato N, Hirata Y, Kyo S, Ono M, Nagai R. Age and preoperative total bilirubin level can stratify prognosis after extracorporeal pulsatile left ventricular assist device implantation. Circ J. 2011;75:121–8.
Maeda T, Tanoue Y, Nakashima A, Tominaga R. Atypical presentation of an apical pseudoaneurysm in a patient on prolonged left ventricular mechanical support. Interact Cardio Vasc Thorac Surg. 2010;10:350–1.
Radovancevic B, Frazier OH, Duncan JM. Implantation technique for the HeartMate left ventricular assist device. J Card Surg. 1992;7:203–7.
Wasler A, Springer WE, Radovancevic B, Myers TJ, Stutts LA, Frazier OH. A comparison between intraperitoneal and extraperitoneal left ventricular assist system placement. ASAIO J. 1996;42:M573–6.
Ushijima T, Tanoue Y, Hirayama K, Nakashima A, Tominaga R. A case of conversion of a NIPRO ventricular assist system to an EVAHEART left ventricular assist system. J Artif Organs. 2013;16:248–52.
Toda K, Yonemoto Y, Fujita T, Shimahara Y, Sato S, Nakatani T, Kobayashi J. Risk analysis of bloodstream infection during long-term left ventricular assist device support. Ann Thorac Surg. 2012;94:1387–93.
Saito S, Matsumiya G, Sakaguchi T, Miyagawa S, Yoshikawa Y, Yamauchi T, Kuratani T, Sawa Y. Risk factor analysis of long-term support with left ventricular assist system. Circ J. 2010;74:715–22.
Shrager JB, Wain JC, Wright CD, Donahue DM, Vlahakes GJ, Moncure AC, Grillo HC, Mathisen DJ. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg. 2003;125:526–32.
Shafii AE, Chamogeorgakis TP, Gonzalez-Stawinski G. Omental flap transposition with intra-abdominal relocation for LVAD pump-pocket infection. J Heart Lung Transplant. 2011;30:1421–2.
Zhang QX, Magovern CJ, Mack CA, Budenbender KT, Ko W, Rosengart TK. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis. J Surg Res. 1997;67:147–54.
Silverman KJ, Lund DP, Zetter BR, Lainey LL, Shahood JA, Freiman DG, Folkman J, Barger AC. Angiogenic activity of adipose tissue. Biochem Biophys Res Commun. 1988;153:347–52.
Matsuyama S, Sonoda H, Yamaki Y, Oishi Y, Tanoue Y, Nishida T, Nakashima A, Shiokawa Y, Tominaga R. Laparotomy for acute cholecystitis after extracorporeal left ventricular assisted system implantation. Jpn J Cardiovasc Surg. 2012;41:304–7 (in Japanese).
Suwa H, Seguchi O, Fujita T, Murata Y, Hieda M, Watanabe T, Sato T, Sunami H, Yanase M, Hata H, Nakatani T. Paracorporeal ventricular assist device as a bridge to transplant candidacy in the era of implantable continuous-flow ventricular assist device. J Artif Organs. 2014;17:16–22.
Yoshioka D, Sakaguchi T, Saito S, Miyagawa S, Nishi H, Yoshikawa Y, Fukushima S, Ueno T, Kuratani T, Sawa Y. Initial experience of conversion of Toyobo paracorporeal left ventricular assist device to DuraHeart left ventricular assist device. Circ J. 2012;76:372–6.
Imamura T, Kinugawa K, Shiga T, Endo M, Kato N, Inaba T, Maki H, Hatano M, Yao A, Nishimura T, Hirata Y, Kyo S, Ono M, Nagai R. Preoperative levels of bilirubin or creatinine adjusted by age can predict their reversibility after implantation of left ventricular assist device. Circ J. 2013;77:96–104.
Conflict of interest
This study did not receive financial support, and the authors declare no conflicts of interest.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Ushijima, T., Tanoue, Y., Onitsuka, H. et al. Operative modification for the prevention of device-related infection during NIPRO extracorporeal left ventricular assist device implantation. J Artif Organs 17, 220–227 (2014). https://doi.org/10.1007/s10047-014-0766-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10047-014-0766-0