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Pressure sore incidence and treatment in Left Ventricular Assist Device (LVAD) -equipped patients: insights from a prospective series

Published:November 24, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.029

      Abstract

      Introduction

      Left ventricular Assistance Device (LVAD) is indicated in patients with end-stage heart failure. Due to the non-physiologic blood flow, LVAD may favor pressure sores with a devastating risk of infection. This work shows prevalence and treatment of pressure sore in LVAD patients, to optimize their management.

      Material and Methods

      We retrospectively investigated all LVAD implantations at the Lausanne University Hospital (CHUV) from 2015 to 2019. We detected patients who developed a pressure sore, and evaluated timeline, management, and outcomes.

      Results

      42 patients benefited from LVAD, among which 5 (12%) developed a stage III/IV pressure sore, within a mean time of 25 days. 4/5 patients were treated surgically and 1/5 conservatively, due to poor overall condition. Half of the patients treated with surgery had major complications requiring reoperation. Mean time to healing for patients after flap coverage was 6 weeks.

      Discussion

      The rapid development of deep pressure sores seen in 12% of patients may be a manifestation of the maladaptive blood flow induced by LVADs, combined with their bedridden condition. Initial signs of pressure sores should be considered seriously, as rapidly evolving and needing an aggressive surgical treatment whenever possible (80%). Complication rate was similar compared to standard pressure sore flap treatment. All patients benefiting from flap surgery achieved effective coverage after a mean follow-up of 24 months. No patient developed LVAD infection.

      Conclusion

      Surgery must be considered early in this population to prevent potential device infection.

      Keywords

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