Cannula exchange for refractory cannula infections during Berlin Heart EXCOR support: a case report

Infection of the cannulae during Berlin Heart EXCOR (BHE) support is a serious complication, with refractory infections often necessitating surgical intervention to prevent their progression to mediastinitis. However, the treatment options for such infections are limited. We report the case of a 4-year-old girl with truncus arteriosus who developed severe heart failure after palliative right ventricular outflow tract reconstruction and aortic valve replacement. The patient successfully underwent a combined surgical procedure consisting of ventricular septal defect and aortic valve closure, redo right ventricular outflow tract reconstruction, and BHE implantation. However, at 10 months after BHE implantation, the outflow cannula exit site was infected by methicillin-resistant Staphylococcus epidermidis . Gallium-67 scintigraphy revealed tracer uptake along the abdominal outflow cannula tract without mediastinal extension. Because the prior aortic valve closure prevented temporary BHE explantation, surgical cannula exchange was performed together with mediastinal irrigation, omental flap transposition, and negative-pressure wound therapy. The infection resolved completely and no recurrent infection was observed during the 1-year follow-up period. In conclusion, cannula exchange combined with omental flap transposition is an effective surgical option for treating refractory cannula infections during BHE support when device explantation is not feasible.