Left ventricular assist device infection is associated with increased mortality but is not a contraindication to transplantation.
Left ventricular assist device infection is associated with increased mortality but is not a contraindication to transplantation.
复制标题
左心室辅助装置感染与死亡率增加相关，但不是移植的禁忌症。
作者：
Mathias Herrmann;M. Weyand;Britta Greshake;C. Eiff;Richard A. Proctor;H. Scheld;Georg Peters
背景
左心室辅助装置（LVAD）越来越多地用作移植的桥梁。感染是与使用这些器械相关的常见和主要并发症，然而，尚未以前瞻性方式评价感染与结局的相关性。
方法和结果
纳入了25例终末期心力衰竭并导致器官功能障碍的患者（24例男性，1例女性）。患者使用Novacor N100便携式LVAD桥接（中位支持时间为55天），并通过器械表面培养物对移植、分离株的分子分型以及感染与移植存活率的相关性进行前瞻性评价。25例患者中有12例（48%）发生LVAD感染，定义为从器械表面回收相同基因型的多个分离株。而12例LVAD感染患者中只有5例（42%）存活至移植，而13例无感染患者中有11例（85%）成功移植（P <0.05）。7例确诊LVAD感染的患者死亡与多器官功能衰竭或其他急性感染体征相关。
结论
LVAD感染与生存概率显著降低相关。它并不排除成功的桥接，而是可能构成紧急移植的指征。
BACKGROUND
Left ventricular assist devices (LVADs) are increasingly used as a bridge to transplantation. Infection is a frequent and major complication associated with the use of these devices, however, the correlation of infection and outcome has not yet been evaluated in a prospective fashion.
METHODS AND RESULTS
Twenty-five patients (24 male, 1 female) with end-stage cardiac failure and resulting organ dysfunction were included. Patients were bridged with the Novacor N100 portable LVAD (median duration of support, 55 days) and were evaluated prospectively by device surface cultures on explantation, molecular typing of isolates, and correlation of infection with survival to transplant. Twelve (48%) of 25 patients had LVAD infection as defined by recovery of multiple isolates of identical genotype from the device surface. Whereas only 5 (42%) of 12 patients with LVAD infection survived until transplantation, 11 (85%) of 13 patients without infection were successfully transplanted (P < .05). Death of the 7 patients with proven LVAD infection was associated with multiple organ failure or other signs of acute infection.
CONCLUSIONS
LVAD infection is associated with a significantly decreased survival probability. It does not preclude successful bridging but rather may pose an indication for urgent transplantation.