Resting and exercise cerebral blood flow in long-term heart transplant recipients

Of 3 patients undergoing drive-line ID he developed a pseudoaneurysm that was emergently surgically treated. The 26 patients with drive-line infection who were treated medically required multiple re-admissions due to worsening drainage. Two of these were admitted in septic shock and were considered not surgical candidates. Ultimately, they succumbed to their infections. Eight of them underwent heart transplantation; 5 had positive intra-operative pump-pocket cultures. Twenty medically treated patients are still alive. Thus, despite improved survival associated with LVAD therapy, infection continues to be a major limiting factor. We believe that surgery should typically be reserved for stable medically intractable infections or patients who present with septic emboli. Pump or pump-pocket infection can be treated with pump exchange or intra-abdominal relocation. Drive-lines should be unroofed to prevent component seeding. Infected pump and pockets should be widely debrided and pumps relocated to prevent them from re-infection. Despite these results, the best alternative to avoid recurrence of LVAD-associated infection appears to be removal of the pump. Therefore, it is imperative that, when device exchange or relocation is contemplated, a thorough work-up be undertaken to prove the patient has not recovered. We currently use a work-up similar to that described by Birks and colleagues. If the patient has recovered, then the decision is made to attempt to explant the device.