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Driveline Relocation and Vacuum-Assisted Closure for Ventricular Assist Device Driveline Infections.

Mehmet Cahit Saricaoglu1, Melisa Kandemir1, Elif M Saricaoglu2

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PubMed
Summary
This summary is machine-generated.

Driveline infections (DLIs) are common after ventricular assist device (VAD) implantation. Surgical management including DL relocation and vacuum-assisted closure (VAC) can help control these serious VAD complications.

Keywords:
driveline dressingdriveline infectionsleft ventricular assist devicesmicroorganisms

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Innovation

Background:

  • Durable mechanical circulatory support (DMCS) infections, particularly ventricular assist device (VAD)-specific driveline infections (DLIs), pose significant challenges.
  • Surgical management of DLIs lacks a defined consensus, highlighting a critical gap in patient care.

Purpose of the Study:

  • To define the incidence, risk factors, and microbiology of DLIs in patients with VADs.
  • To discuss and evaluate surgical treatment modalities for VAD driveline infections.

Main Methods:

  • Retrospective review of 90 patients who underwent LVAD or BiVAD implantation between March 2011 and May 2023.
  • Analysis of VAD type (HeartMate 2, HeartWare HVAD, HeartMate 3) and patient data to identify DLI risk factors and outcomes.

Main Results:

  • DLIs occurred in 21.5% of patients, with a higher incidence of late-onset DLIs associated with longer VAD support duration (p < 0.05).
  • Independent predictive factors for DLI risk included younger age (HR 9.77) and lower plasma albumin levels (HR 10.55).
  • Surgical interventions like biofilm removal, driveline relocation through rectus muscle, and vacuum-assisted closure (VAC) were employed in nine patients, with one recurrent infection and one heart transplant post-DLI.

Conclusions:

  • DLIs are frequent and serious complications of VAD implantation, impacting patient autonomy, quality of life, and survival.
  • Driveline relocation and VAC strategies show promise in managing DLIs effectively.