Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Patients with Continuous-Flow Left Ventricular Assist Devices (LVAD)

Ryan Cobb, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery, Thomas Jefferson University, Philadelphia, USA.

DOI: 10.4236/wjcs.2013.32017                

Abstract

Introduction: Inadequate nutritional support after LVAD placement is known to increase postoperative infections and to decrease survival. LVAD patients with prolonged mechanical ventilation and complicated postoperative recovery requiring prolonged mechanical ventilation may require long-term tube feedings. Placement of a PEG requires knowledge of the location of the LVAD pocket and driveline to avoid device infection and injury. Methods: Between August 2008 and December 2011, 39 patients underwent HeartMate II LVAD placement in our institution. Among them, 5 patients underwent PEG tube placement for long-term nutritional support. Procedure management consisted of cessation of anticoagulation and correction of abnormal coagulation; a cardiothoracic surgeon or intensivist in the operating room to communicate with the surgeon who performed the PEG procedure; and VAD coordinator or perfusionist in the operating room to assist in monitoring the VAD. Data were retrospectively analyzed to investigate complications related to the PEG placement. Results: The studied patients consisted of 3 males and 2 females with mean age of 58 +/﹣5.0. The interval of LVAD to PEG placement was a mean 21 +/﹣8.8 days. PEG was successfully performed in the operating room in all patients. There were no LVAD device or driveline injuries related to the PEG procedure. There were no postoperative short-term or long-term PEG related complications such as acute gastric bleeding or dislodgement of the PEG tube. Conclusions: PEG placement for HeartMate II LVAD patients can be done without increasing the risk of device or intraabdominal organ injury with carefully coordinated efforts from both the mechanical support team and surgical services.

Keywords

Heart Failure; Mechanical Support Device; Nutrition; PEG

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Beiras-Fernandez, F. Kur, S. Kiefer, R. Sodian, M. Schmoeckel, M. Weis, B. Reichart and F. Weis, “Multidrug-Resistant Gram-Positive Infections in Patients with Ventricular Assist Devices: The Role of Daptomycin,” Transplantation Proceedings, Vol. 41, No. 6, 2009, pp. 2589-2591. doi:10.1016/j.transproceed.2009.06.126
[2]	Z. W. Xu and Y. S. Li, “Pathogenesis and Treatment of Parenteral Nutrition-Associated Liver Disease,” Hepatobiliary & Pancreatic Diseases International, Vol. 11, No. 6, 2012, pp. 586-593. doi:10.1016/S1499-3872(12)60229-X
[3]	S. P. Yang, Y. Y. Chen, H. H. Hsu, F. D. Wang, L. Y. Chen and C. P. Fung, “A Risk Factor Analysis of Healthcare-Associated Fungal Infections in an Intensive Care unit: A Retrospective Cohort Study,” BMC Infectious Diseases, Vol. 13, 2013, p. 10. doi:10.1186/1471-2334-13-10
[4]	I. I. Raad and G. P. Bodey, “Infectious Complications of Indwelling Vascular Catheters,” Clinical Infectious Diseases, Vol. 15, No. 2, 1992, pp. 197-208. doi:10.1093/clinids/15.2.197
[5]	T. I. van der Kooi, J. C. Wille and B. H. van Benthem, “Catheter Application, Insertion Vein and Length of ICU Stay Prior to Insertion Affect the Risk of Catheter Related Bloodstream Infection,” Journal of Hospital Infection, Vol. 80, 2012, pp. 238-244. doi:10.1016/j.jhin.2011.11.012
[6]	E. Kostadima, A. G. Kaditis, E. I. Alexopoulos, E. Zakynthinos and D. Sfyras, “Early Gastrostomy Reduces the Rate of Ventilator-Associated Pneumonia in Stroke or Head Injury Patients,” European Respiratory Journal, Vol. 26, 2005, pp. 106-111. doi:10.1183/09031936.05.00096104
[7]	J. A. Morgan, G. Paone, H. W. Nemeh, S. E. Henry, R. Patel, J. Vavra, C. T. Williams, D. E. Lanfear, C. Tita and R. J. Brewer, “Gastrointestinal Bleeding with the Heart-Mate II Left Ventricular Assist Device,” The Journal of Heart and Lung Transplantation, Vol. 31, No. 7, 2012, pp. 715-718. doi:10.1016/j.healun.2012.02.015
[8]	A. L. Meyer, C. Kuehn, J. Weidemann, D. Malehsa, C. Bara, S. Fischer, A. Haverich and M. Strüber, “Thrombus Formation in a HeartMate II Left Ventricular Assist Device,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 135, No. 1, 2008, pp. 203-204. doi:10.1016/j.jtcvs.2007.08.048
[9]	M. S. Slaughter, J. G. Rogers, C. A. Milano, S. D. Russell, J. V. Conte, D. Feldman, B. Sun, A. J. Tatooles, R. M. Delgado 3rd, J. W. Long, T. C. Wozniak, W. Ghumman, D. J. Farrar and O. H. Frazier, “Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device,” The New England Journal of Medicine, Vol. 361, No. 23, 2009, pp. 2241-2251. doi:10.1097/00002480-200011000-00034
[10]	T. J. Myers, T. Khan and O. H. Frazier, “Infectious Complications Associated with Ventricular Assist Systems,” ASAIO Journal, Vol. 46, No. 6, 2000, pp. S28-S36.
[11]	M. H. Akay, I. Gregoric, W. E. Cohn and O. H. Frazier, “HeartMate-II Left Ventricular Assist Device Infections Resulting from Gastrointestinal-Tract Fistulas,” Journal of Cardiac Surgery, Vol. 27, No. 5, 2012, pp. 643-645. doi:10.1111/j.1540-8191.2012.01517.x