A middle-aged man suffered severe complications after using a Heartmate II Left Ventricular Assist Device, or “LVAD,” causing him to file suit against the device’s manufacturer and his doctor. Diagnosed with a non-ischemic dilated cardiomyopathy, the patient’s left ventricle was dilated, unable to fully pump blood and on the verge of restricting its flow entirely. His LVAD was removed in preparation of a heart transplant, and he developed a wound on his sternum which refused to heal. The infection persisted even after his sternal wires were removed and a wound VAC was applied; nearly a year later, a scan revealed that a large abscess had developed in the area around the patient’s liver, right next to where the LVAD’s driveline tube had rested. The infection was allegedly due to the abscess caused by the device, and the case requested an expert who could comment on the device and its reputation.
Question(s) For Expert Witness
1. How often do you remove LVADs?
2. What care is taken to make sure the entire device is removed?
3. What should the work up include for a persistent sternal wound infection with no identifiable source?
Expert Witness Response E-055328
I regularly remove LVADs within my practice. There is the possibility that the driveline can be separated into pieces during the removal, which makes it all the more important to ensure after the operation that all of the material has been removed through documentation. A persistent sternal wound infection is not common, and I would need to review the records to determine the extent of the abscess since the location of the abscess and the driveline are not the same.
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