Perioperative Prophylaxis for Total Artificial Heart Transplantation

H. E. Chambers, Peggy L Pelish, F. Qiu, Diana F Florescu

Research output: Contribution to journalArticle

Abstract

Background Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. Methods An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. Results The majority of centers (80.8%) had a formal surgical infection prophylaxis protocol. For non–penicillin-allergic patients, five (20.1%) institutions reported using a 4-drug regimen, seven (29.2%) used a 3-drug regimen, five (20.1%) used a 2-drug regimen, and seven (29.2%) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2% centers. During the first month after TAH-t, bacteremia represented 27.3%, driveline infections 27.2%, pulmonary infections 9%, and mediastinal infections 18.2%. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4%). In 65% of centers, the mean rate of death post–TAH-t due to infection was 14.5% (SD, 22.3%). The mean rate of patients surviving until orthotopic heart transplantation was 58.6% (SD, 27.7%). Conclusions Preventing infections post–TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol.

Original languageEnglish (US)
Pages (from-to)2169-2175
Number of pages7
JournalTransplantation Proceedings
Volume49
Issue number9
DOIs
StatePublished - Nov 2017

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Artificial Heart
Heart Transplantation
Infection
Pharmaceutical Preparations
Mortality
Cephalosporins
Bacteremia
Candida
Penicillins
Pseudomonas aeruginosa
Escherichia coli
Morbidity
Lung

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Perioperative Prophylaxis for Total Artificial Heart Transplantation. / Chambers, H. E.; Pelish, Peggy L; Qiu, F.; Florescu, Diana F.

In: Transplantation Proceedings, Vol. 49, No. 9, 11.2017, p. 2169-2175.

Research output: Contribution to journalArticle

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abstract = "Background Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. Methods An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. Results The majority of centers (80.8{\%}) had a formal surgical infection prophylaxis protocol. For non–penicillin-allergic patients, five (20.1{\%}) institutions reported using a 4-drug regimen, seven (29.2{\%}) used a 3-drug regimen, five (20.1{\%}) used a 2-drug regimen, and seven (29.2{\%}) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2{\%} centers. During the first month after TAH-t, bacteremia represented 27.3{\%}, driveline infections 27.2{\%}, pulmonary infections 9{\%}, and mediastinal infections 18.2{\%}. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4{\%}). In 65{\%} of centers, the mean rate of death post–TAH-t due to infection was 14.5{\%} (SD, 22.3{\%}). The mean rate of patients surviving until orthotopic heart transplantation was 58.6{\%} (SD, 27.7{\%}). Conclusions Preventing infections post–TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol.",
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AB - Background Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. Methods An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. Results The majority of centers (80.8%) had a formal surgical infection prophylaxis protocol. For non–penicillin-allergic patients, five (20.1%) institutions reported using a 4-drug regimen, seven (29.2%) used a 3-drug regimen, five (20.1%) used a 2-drug regimen, and seven (29.2%) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2% centers. During the first month after TAH-t, bacteremia represented 27.3%, driveline infections 27.2%, pulmonary infections 9%, and mediastinal infections 18.2%. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4%). In 65% of centers, the mean rate of death post–TAH-t due to infection was 14.5% (SD, 22.3%). The mean rate of patients surviving until orthotopic heart transplantation was 58.6% (SD, 27.7%). Conclusions Preventing infections post–TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol.

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