Residual foreign body and frequency of infection after heart transplantation
Michiru Nomoto1, Noriko Kikuchi1, Hidetoshi Hattori1, Ryogo Houki2, Yuki Ichihara2, Satoshi Saito2, Hiroshi Niinami2, Nobuhisa Hagiwara1, Shinichi Nunoda3.
1Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan; 2Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan; 3Therapeutic Strategy for Severe Heart Failure, Tokyo Women's Medical University Graduate School of Medicine, Tokyo, Japan
Background: Patients with severe heart failure who require left ventricular assist device (LVAD) has been often accompanied by implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT) at the list of candidate for heart transplantation. When implanting a ventricular assist device (LVAD), an expanded polytetrfluoroethylene (ePTFE) sheet is often used for preventing adhesion of artificial blood vessels and pumps. The parts of these leads and ePTFE sheets may remain in the body at the time of heart transplantation, but the relation between remaining these foreign bodies and the post-transplant clinical course has not been clear. The aim of this study was to clarify the post-transplant infection events which were concerned by remaining foreign bodies.
Methods: Of 31 patients who underwent heart transplantation at Tokyo Women's Medical University Hospital from 2001 to 2019, 27 patients receiving the examination of CT before and after surgery were included. The target patients identified residual foreign bodies from CT and from the operation records.
Results: Average observation period was 51 ± 40 months. The average age at the time of transplantation was 41 ± 12 years. Devices of implantable LVAD of 26 cases consisted of EVAHEART in 24 and HeartMate II in 2 cases, and one case received an extracorporeal ventricular assist device (Toyobo). The average time from implantation of a ventricular assist device to transplantation was 37 ± 14 months. Of the 27 patients, 22 (81.4%) had residual foreign bodies in the body after heart transplantation. The foreign bodies consisted of shock coil or lead in 9 cases (33.3%), blood vessels in 9 cases (33.3%), and ePTFE sheet in 10 cases (37.0%). Three of 22 cases (13.6%) with residual foreign body showed foreign body-related infection after transplantation, then foreign body extraction was performed.
Conclusion: Patients who underwent heart transplantation after implantation of a LVAD have relatively frequent residual foreign bodies. Because of post-transplant immunosuppressive therapy, residual foreign bodies should be removed as much as possible.
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