Sinan Sabit KOCABEYOĞLU, Doğan Emre SERT

Sol ventrikül destek cihazı implantasyonu sonrası driveline ile ilişkili enfeksiyonlar: Tek merkez deneyimi

Amaç: Sol ventrikül destek cihazı sonrası görülen en sık komplikasyon driveline kaynaklı enfeksiyonlardır. Bu komplikasyon hastaların hayat kalitesini ileri derecede bozmaktadır. Bu çalışmanın amacı sol ventrikül destek cihazı takılan hastalarda driveline enfeksiyonlarını araştırmak ve tedavi stratejimizi ortaya koymaktır. Gereç ve Yöntemler: Mayıs 2013 ile Ekim 2018 tarihleri arasında sol ventrikül destek cihazı takılan 90 erişkin hasta çalışmaya dahil edildi. Driveline enfeksiyon oranları, özellikleri, patojen mikroorganizmalar araştırıldı. Ayrıca enfeksiyonlara karşı uygulanan tedavi seçenekleri incelendi. Bulgular: Hastaların ortalama yaşları 46,3 ± 13,7 idi ve %83,3’ ü (75/90) erkekti. Hastaların %62,2’ sinde dilate kardiyomiyopati mevcuttu. Tüm hastaların %35,5’inde (32/90) driveline enfeksiyonu tespit edildi. İmplantasyon ve driveline enfeksiyonu görülme arasında geçen ortalama süre 304±309(15-1500) gündü. Alınan sürüntü ve/veya doku kültürlerinde en çok tespit edilen mikroorganizmalar gram pozitif koklar idi. Yedi hastada oral antibiyotik, 25 hastada ise hastaneye yatırılarak sistemik antibiyotik tedavisine gereksinim duyuldu. On üç hastada oral/sistemik antibiyotik tedavisi ile enfeksiyon kontrol altına alırken 15 hastada ise cerrahi olarak debridman yapıldı, üç hastada driveline daha yukarı bir bölgeye taşındı ve bir hastaya kalp nakli gerekti. Hiçbir hastada cerrahi olarak cihazın çıkarılmasını gerektirecek kontrolsüz enfeksiyona rastlanmadı. Sonuç: Sol ventrikül destek cihazları yüksek oranda driveline enfeksiyonu oranlarına sahiptir; bu çalışmada oran 1. yılda %24,4 olarak bulunmuştur. Oral veya sistemik antibiyotik tedavisi ile ve/veya seçilmiş vakalarda debridman tedavisi ile enfeksiyon kontrol altına alınmış, nadiren driveline kablosunun taşınması ve kalp nakline ihtiyaç duyulmuştur.

Anahtar Kelimeler:

Sol ventrikül destek cihazı, driveline enfeksiyonu, çıkış yeri.

Driveline-related infections after left ventricular assist device implantation: A single center experience

Aim: The most common complication after left ventricular assist device implantation is driveline-induced infections. This complication severely deteriorates quality of life of the patients. The aim of this study was to investigate driveline infections in patients with left ventricular assist device and to introduce our treatment strategy. Material and Methods: Between May 2013 and October 2018, 90 adult patients who underwent left ventricular assist device implantation were included. Driveline infection rates, characteristics, pathogen microorganisms were investigated. Treatment options for infections were also analyzed. Results: The mean age of the patients was 46.3 ± 13.7 and 83.3% (75/90) were male. Dilated cardiomyopathy was present in 62.2% of the patients. Driveline infection was detected in 35.5% (32/90) of the patients. The mean time between implantation and driveline infection was 304 ± 309 (15-1500) days. The most commonly detected microorganisms from swabs and/or tissue cultures were gram positive cocci. Seven patients required oral antibiotic treatment whereas 25 patients required systemic antibiotic treatment. While infection was controlled by oral/systemic antibiotic therapy in 13 patients, 15 patients underwent surgical debridement, three patients required translocation and heart transplant was required in one patient. None of the patients had uncontrolled infection requiring device extraction. Conclusion: Left ventricular assist device implantation carries high risk of driveline infection; In this study, the rate was found to be 24.4% in the first year. Infection was controlled by oral or systemic antibiotic therapy and/or debridement therapy in selected cases, driveline translocation and heart transplant were rarely required.

Keywords:

Left ventricular assist device, driveline infection, exit site.,

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