Anesthesia in Patient with Left Ventricular Assist Device Support. A Case Report.

Abstract

Background; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms.
 Case presentation; A 48-year-old patient 72 kg, height 172 cm with dilated cardiomyopathy, his course was complicated by pump failure requiring LVAD HeartMate III placement 3 years (Milan Italy). The parameters of the LVAD pump were determined for the patient from the moment of the Pump speed 5300 rpm Flow 4.4 lpm was set. The patient performed moderate activity under normal conditions. The patient regularly took Coumadin to keep the recommended INR levels at the recommended target values ​​2.5. At the site of the exit of the cavity from the skin in the region of the right hypochondrium, there was an infection that for a long time was treated with various schemes with ambulatory antibiotics
 Conclusions; In the present case we showed that successful eradication of a chronic LVAD driveline infection was only possible when approached both surgically and conservatively. It is important to note that a good knowledge of the physiopathology of heart failure, the widest possible information on the treatment of heart failure with the help of LVAD implantation is very important in the treatment and survival of these patients.