Search

We describe a very rare case of outflow cannula obstruction with fungal infectious thrombus formation. Discussion includes the etiology, diagnosis, and management of fungal infection complications related with long-term mechanical circulatory support. Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure. Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [Ann Thorac Surg 90:1270-1277, 2010]. Device-related infections can be categorized as driveline infections, pump-pocket infections, and LVAD-associated endocarditis [Expert Rev Med Devices 8: 627-634, 2011]. The microbiological profile is very heterogeneous; the most common pathogens are Staphylococcus, Pseudomonas, Streptococcus species, and Candida. Severe fungal infection may lead to dysfunction of the LVAD due to obstructive mass formation within the device. Due to the only anecdotal reports in the current literature, we present a very rare case of outflow fungal infectious thrombus formation leading to outflow cannula obstruction in patient with LVAD.

Background Even if better clinical outcomes have been achieved with the implantation of newer generation continuous-flow left ventricular assist devices (LVADs), infection complications are still a major risk for these patients in longterm follow-up. We present a case of a 56-year-old male with dilated cardiomyopathy who was urgently implanted with left ventricular assist device HeartMate II. During the entire postoperative period, we observed repeated life-threatening septic complications. Clinical signs of infection disappeared after prolonged treatment with broad-spectrum antibiotics and patient was discharged to outpatient monitoring. During the entire duration of circulatory support, no LVAD suction events were detected, pump power consumption remained in the normal range and the patient was listed for heart transplantation. Patient was two month rehospitalized due to worsening of his status. Hemoglobinuria, an increase of inflammatory markers, and alteration in hepatic and renal function were detected. TEE imaging showed no obstructive formation in inflow or outflow cannulas; only velocities were decreased. The LV was severely dilated and the aortic valve was opening at each contraction. Patient was initially considered for systemic thrombolysis, but this urgent status was finally solved with explantation of the LVAD and subsequent heart transplantation. Massive obstruction with thrombuslike formation was found in the outflow cannula. Histopathologic examination and microbiologic culturing of the mass showed extensive fungal growth (Aspergillus species). During the postoperative period, patient was aggressively treated with antifungal therapy. He was discharged 8 weeks after the transplantation. Conclusion We believe that clinical decision-making in patients with signs of ongoing sepsis and end-organ dysfunction together with any signs of LVAD malfunction should be very straightforward in terms of device exchange or explantation.

Advances in palliation of congenital heart disease have resulted in improved survival to adulthood. Nevertheless many of these patients ultimately develop end-stage heart failure requiring heart transplantation. Implantation of ventricular assist device is life-saving option for such patients, allowing for bridge to transplant. In the present study we describe our experience with implantation of ventricular assist device Heart Mate II as bridge to transplant in adult patients with congenital heart disease.

Advances in palliation of congenital heart disease have resulted in improved survival to adulthood. Many of these patients develop end-stage heart failure requiring heart transplantation. In this study we analyzed the clinical profile and outcome of congenital heart disease patients transplanted at our institution.

Background Late infections (more than month post implantation) seem to be significant factor of higher morbidity and mortality in patients with implanted mechanical circulatory support (MCS). The aim of our study was to evaluate occurrence of infectious complications (driveline, pump-pocket) in patients with implanted MCS. Methods Data of patients (n = 106), whom was implanted MCS HeartMate II in indication “bridge to transplant” from 11.12.2006 to 3.4.2013 were retrospectively analyzed. Infections were diagnosed on the base of macroscopic finding, positive wound cultivation and laboratory markers of inflammation. Results 82 (77.4 %) patients were without infection, 7 (6.7 %) patients developed pump-pocket infection and in 17 (16 %) patients occurred driveline infection. Patients were divided according to driveline technical implantation to three groups: 58 patients with classic/direct technique, 12 patients with „C-shape technique- velour coated“ and 36 patients with „C-shape technique - plastic exit site“. Driveline infection was observed in 13 patients with direct technique (0.28 patient per year), in 3 „velour coated“ patients (0.20 patient per year) and in 1 patient with „plastic exit site“(0.068 patient per year). From this group 15 patients were successfully transplanted, 1 device was explanted, 6 patients died (only 2 patients on infection related complications) and 1 patient is currently on waiting list. Conclusion Late infections are the relevant factor of morbidity and mortality. Despite driveline or pump pocket infections 67 % patients were successfully transplanted or explanted after receiving an appropriate treatment. C-shape method of driveline implantation, especially its plastic site variant, seems to be the method of choice.