A silver lining in the VAD sky? Impact of a silver dressing on left ventricular assist device-associated driveline...

Left ventricular assist devices (LVAD) constitute a mainstay of treatment for patients suffering from advanced heart failure. LVAD have been shown to significantly increase patient survival and quality of life. The therapy continues to be hampered by LVAD-specific complications that limit its wider appeal. Driveline infections (DLI) remain the Achilles' heel of LVAD therapy, with persistent rates of DLI plaguing many patients. Several studies have been carried out to evaluate the effectiveness of driveline dressing protocols, but there is no consensus on specific driveline management, and no prospective trial has ever been carried out.

We conducted a single-center prospective randomized trial of a driveline dressing protocol to evaluate the safety and efficacy of a weekly silver patch-based driveline dressing kit. The Control group protocol included every 3 days changes with chlorhexidine cleansing, an occlusive dressing, and an anchoring device. The Silver group protocol included weekly dressing changes with chlorhexidine cleansing, a non-activated silver patch, an occlusive dressing, and an anchoring device. Twenty-three patients were enrolled in the study, with 11 in the control group and 12 in the silver group. The endpoints of the study were the occurrence of the first DLI, time to first DLI, and total number of DLI at 18 months. We used SAS to assess the significance of the primary endpoint.

At an average 18-month follow-up, the first DLI rate (0.061 vs 0.377 events per patient year [EPPY], p = 0.01) as well as the total DLI rate (0.061 vs 0.754 EPPY, p = 0.002) was lower in the intervention arm. The mean time to first DLI was longer in the intervention arm (432 vs 187 days, p = 0.05).

A weekly driveline dressing protocol that includes a non-activated silver patch may provide protection against driveline infections.