Abstract
Background: The optimal local care of continuous-flow left ventricular-assisted device (CF-LVAD) exit site in unclear. We compared silver-coated wound dressing (Acticoat) with the conventional wound care method. Methods: A retrospective case-control study was conducted at Henry Ford Hospital, a tertiary teaching hospital in urban Detroit, between 11/1/2010 and 12/31/2011. Patients were divided into 2 groups based on Acticoatdressing use. Primary outcome was first CF-LVAD infection rate. Results: Forty-two patients were included in the study. Twenty patients used Acticoat-dressing, while 22 used the control dressing. Mean age was 60.3 ± 8.9 in the intervention group and 48.6 ± 4.8 in the control group (P: 0.004). Male patients were 15 (75%) in the intervention group and 15 (68.2%) in the control group (P: 0.74). Acticoat-dressing was used for a mean duration of 64.1 ± 122.9 days. The rate of first CF-LVAD infection was 15% (3) in the Acticoat group and 31.8% (7) in the control group (P: 0.25). Mortality at 200 days was 15% (3) in the intervention group; and 4.5% (1) in the control group (P: 0.25). Ten patients were infected in the whole study (23.8%); 9 of the infected patients (90%) required hospitalization after the first infection; while 3 patients (30%) required intensive-care unit admission. Mean time to the first infection was 276.3 ± 235.8 days in the intervention group and 276.3 ± 131.5 days in the control group (P: 0.99). Conclusion: There was no statistically significant difference in the infection rate or time to first infection between the Acticoat group and the control group.
Highlights
Implantation of continuous-flow left-ventricular-assisted device (CFLVAD) has been consistently shown to reduce mortality rate, alleviate symptoms, improve organ perfusion, and facilitate transplantation for patients with end-stage heart failure [1]
Mortality analysis at 200 days postimplantation showed that 3 (15%) patients died in the intervention group; while 1 (4.5%) patient died in the control group (P: 0.249)
Ten patients were infected in the whole study (23.8%); 9 of the infected patients (90%) required hospitalization after the first CFLVAD infection; while 3 patients (30%) required intensive-care unit (ICU) admission
Summary
Implantation of continuous-flow left-ventricular-assisted device (CFLVAD) has been consistently shown to reduce mortality rate, alleviate symptoms, improve organ perfusion, and facilitate transplantation for patients with end-stage heart failure [1]. Infection could involve the driveline exit-site, the device pocket or the pump/cannula [1]. These infectious complications increase the morbidity and mortality in this population [1]. The initial post-operative wound care involved daily or twice daily dressing changes with a local disinfectant (chlorhexidine). A silver-coated wound dressing (Acticoat) that only requires changing every 72 hours was recently introduced as part of the standard topical hygiene measures in patients with CF-LVAD. To date there are limited data describing the effect of this particular method of local wound care on the epidemiology and incidence of post-operative infections in this patient population. The optimal local care of continuous-flow left ventricular-assisted device (CF-LVAD) exit site in unclear. We compared silver-coated wound dressing (Acticoat) with the conventional wound care method
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