Pedicled Flap Closure as an Adjunct for Infected Ventricular Assist Devices

Purpose: End-stage cardiac disease has resulted in an increased utilization of cardiac transplantation or long-term mechanical assistance to sustain life. Though left ventricular assist devices (LVAD) have revolutionized the treatment algorithm for these patients, these devices carry a substantial infection rate, ranging from 30% to 50%. We report our institution's experience with attempted flap salvage for infected and exposed LVADs. Methods: A retrospective review for all LVAD-related infections treated with flaps at our institution from 2010 to 2015. Results: Twenty flaps were performed in 15 patients during the study period. Average age was 54 years. There were 4 women and 11 men with average body mass index of 30.6. Surgery was indicated for LVAD motor or drive line exposure in the setting of infection in all cases. Rectus abdominus (n = 10), omentum (n = 6), pectoralis major (n = 3), and intercostal (n = 1) were used for coverage. Complications resulted in approximately 67% of cases including hematoma (n = 4), seroma (n = 3), cellulitis (n = 1), and total flap loss (n = 1). Conclusions: Left ventricular assist devices are lifesaving interventions for patients with severe cardiac disease but are associated with a high rate of infectious complications over time. Although device coverage carries a high rate of complications, no devices required exchange due to infection or failed attempts at salvage.

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