植込み型補助人工心臓のデバイス感染対策のための大網充塡術

Omental Flap for the Device Infection of the HeartMateⅡ

植込み型補助人工心臓（implantable ventricular assist device：iVAD）に関連して合併する術創部感染は，ドライブライン感染やポンプポケット感染を引き起こして重篤な経過をたどる．われわれは拡張型心筋症（dilated cardiomyopathy：DCM）で体外式補助人工心臓（extracorporeal VAD：eVAD）を装着してから心移植待機登録をして，iVADへの植替え手術（bridge-to-bridge：BTB）によりHeartMateⅡ（Abbott Laboratories社，Chicago）を植込んだ2例において，デバイス感染対策として大網充塡術を行って良好な結果を得たので報告する．

Case 1：An 18-year-old male underwent emergent left extracorporeal ventricular assist device （eVAD） implantation for a cardiogenic shock because of dilated cardiomyopathy （DCM）. After listing for heart transplant, he underwent a HeartMateⅡ implantation as bridge-to-bridge （BTB） therapy. The omental flap was simultaneously used to prevent device infection that could have been induced by the infected malgranulation around the cannulas of the eVAD. Eventually, he was discharged and waiting for transplantation.

Case 2：A 30-year-old male with DCM underwent emergent eVAD implantation for left ventricular support, centrifugal veno-pulmonary artery extracorporeal membrane oxygenation （ECMO） for right ventricular and respiratory support, and mitral valve replacement. After weaning of ECMO, he was listed for a heart transplant and underwent a HeartMateⅡ implantation as BTB therapy. However, liver dysfunction and malnutrition prolonged wound healing. Despite applying vacuum assist closure device to promote wound healing, part of the driveline and pump housing were exposed. Therefore, radical debridement and omentopexy were performed for infection control. He was discharged after complete wound healing.