Background
Delayed sternal closure may be required after left ventricular assist device (LVAD)
implantation due to coagulopathy or hemodynamic instability. There is conflicting
data regarding infection risk.
Methods
We performed a single-center, retrospective analysis of patients who received their
first LVAD between May 2012 and January 2021. Patients were divided into delayed sternal
closure (DSC) and primary sternal closure (PSC) groups. We used chi-squared or Fisher
Exact tests, as appropriate, to compare the incidence of postoperative LVAD-related
infections (mediastinal/sternal wound) and LVAD-specific infections (driveline and
pump pocket) after definitive chest closure between these two groups.
Results
A total of 327 patients met eligibility criteria, including 127 (39%) patients that
underwent DSC and 200 (61%) patients that had a PSC. Demographic and clinical characteristics
were similar except for an overrepresentation of men (87% vs. 75%, p = .016), Interagency Registry of Mechanically Assisted Circulatory Support class
I-II patients (89% vs 66%, p < .001), patients with a previous sternotomy (43% vs 13%, p < .001), and patients with chronic kidney disease (55% vs 43%, p = .030) in the DSC group. The median DSC time was 24 (IQR: 24-48) hours. The incidence
of LVAD-related mediastinal/sternal wound infection was similar between the DSC and
PSC groups (4.7% vs 3.0%, p = .419). There was no difference between DSC and PSC groups in the incidence of driveline
infection (6.3% vs 9%, p = .411) and pump pocket infection (1.6% vs 1.5%, p =.901), respectively.
Conclusions
DSC does not seem to increase the incidence of LVAD-related or LVAD-specific infection
rates in heart failure patients undergoing device implantation surgery.
KEYWORDS
Abbreviations:
CPB (cardiopulmonary bypass), DSC (delayed sternal closure), INTERMACS (Interagency Registry of Mechanically Assisted Circulatory Support), ISHLT (International Society for Heart and Lung Transplant), LVAD (left ventricular assist device), PSC (primary sternal closure)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 10, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
