دورية أكاديمية
Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score.
| العنوان: | Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score. |
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| المؤلفون: | Finnan MJ; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis MO., Chi D; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis MO., Chiang SN; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis MO., Vader JM; Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO., Cabrera NL; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO., Kells AF; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis MO., Masood MF; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO., Kotkar KD; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO., Fox IK; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis MO. |
| المصدر: | Journal of the American College of Surgeons [J Am Coll Surg] 2024 Apr 23. Date of Electronic Publication: 2024 Apr 23. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 9431305 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1190 (Electronic) Linking ISSN: 10727515 NLM ISO Abbreviation: J Am Coll Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : [Baltimore, MD] : Lippincott Williams & Wilkins, Inc. Original Publication: Chicago, Ill. : The College, c1994- |
| مستخلص: | Background: Left ventricular assist devices (LVAD) improve survival for patients with cardiac failure, but LVAD specific infections (VSI) remain a challenge with poorly understood predictive risk factors. Furthermore, the indications and utility of escalating medical treatment to surgical debridement and potential flap reconstruction are not well-characterized. Study Design: A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed. The primary outcomes measures were 90-day and overall mortality after VSI. Cox proportional hazards regression was used to generate a risk-prediction score for mortality. Results: Of the 760 patients undergoing primary LVAD implantation, 255 (34%) developed VSI; of these 91 (36%) were managed medically, 134 (52%) with surgical debridement, and 30 (12%) with surgical debridement and flap reconstruction. One-year survival after infection was 85% with median survival of 2.40 years. Factors independently associated with increased mortality were diabetes (hazard ratio (HR) 1.44, p=0.04), methicillin-resistant Staphylococcus aureus infection (HR 1.64, p=0.03), deep space (pump pocket/outflow cannula) involvement (HR 2.26, p<0.001) and extra-corporeal membrane oxygenation after LVAD (HR 2.52, p<0.01. Factors independently associated with decreased mortality were flap reconstruction (HR 0.49, p=0.02) and methicillin-sensitive Staphylococcus aureus infection (HR 0.63, p=0.03). A clinical risk prediction score was developed using these factors and showed significant differences in median survival, which was 5.67 years for low-risk (score 0-1), 3.62 years for intermediate-risk (score 2), and 1.48 years for high-risk (score >3) (p<0.001) patients. Conclusions: We developed a clinical risk prediction score to stratify VSI patients. In selected cases, escalating surgical treatment was associated with increased survival. Future work is needed to determine if early surgical debridement and flap reconstruction can alter outcomes in select cases of VSI. (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.) |
| تواريخ الأحداث: | Date Created: 20240423 Latest Revision: 20240423 |
| رمز التحديث: | 20240424 |
| DOI: | 10.1097/XCS.0000000000001096 |
| PMID: | 38651731 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1879-1190 |
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| DOI: | 10.1097/XCS.0000000000001096 |