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Absorbable antibiotic beads for treatment of LVAD driveline infections
Ishaq Wadiwala1, Pankaj Garg1, Emad Alamouti-Fard1
1Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.
Backgound:
Infections of the left ventricular assist device (LVAD) driveline are a dreaded complication that results in high mortality and morbidity.
Method:
We retrospectively reviewed five consecutive patients with severe continuous-flow LVAD (HVAD, Heartmate 2, and Heartmate 3) driveline infection. These infections, which developed on an average of 960.4 ± 843.9 days after LVAD placement, were refractory to systemic antibiotics and local wound care. All were treated with extensive surgical debridement, local installation of absorbable antibiotic-loaded calcium sulfate beads (vancomycin and tobramycin), primary wound closure, and 6 weeks of systemic antibiotics after surgery.
Results:
Four patients had resolution of DLI, and one had a recurrent infection at another part of the driveline 7 months after the complete resolution of the previous site. This patient was successfully treated with debridement and bead placements. Three patients still have their LVADs, while two received orthotopic heart transplants. At the time of the transplant, there was no evidence of gross infection of the LVAD drivelines or pumps. At the average follow-up time of 425.8 ± 151 days, no patients have an active infection.
Conclusion:
Treatment of LVAD driveline infection with absorbable antibiotic beads with primary wound closure is a viable option and merits further investigation.
Insights
Left ventricular assist device (LVAD) driveline infections are serious complications. Surgical debridement with antibiotic-loaded beads offers a viable treatment option for these refractory infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Left ventricular assist device (LVAD) driveline infections represent a significant challenge, associated with high mortality and morbidity.
- These infections often prove refractory to conventional treatments like systemic antibiotics and local wound care.
Observation:
- A retrospective review of five patients with severe, continuous-flow LVAD driveline infections was conducted.
- Infections occurred significantly after LVAD implantation (average 960.4 days) and required aggressive management.
Findings:
- All patients underwent surgical debridement, placement of vancomycin and tobramycin-loaded calcium sulfate beads, and primary wound closure.
- Four out of five patients achieved resolution of driveline infection; the fifth patient had a successful re-treatment for recurrence.
- At an average follow-up of 425.8 days, no patients exhibited active infection, with three retaining their LVADs and two receiving heart transplants without gross infection.
Implications:
- This treatment approach, combining surgical debridement with antibiotic-loaded absorbable beads and primary closure, appears effective for LVAD driveline infections.
- Further investigation into this therapeutic strategy is warranted to establish its broader clinical utility.
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