Driveline Relocation With Omentoplasty for Severe Ventricular Assist Device-Specific Infection

Percutaneous driveline infections (DLI) are a serious complication in patients with a durable ventricular assist device, affecting approximately 50% within 5 years. When conservative treatment fails, driveline relocation combined with omentum major wrapping (OMW), leveraging its anti-inflammatory properties, may serve as a bailout approach. In this retrospective single-center analysis, 72 patients who underwent driveline relocation with OMW for severe DLI between October 2015 and September 2024 were included. The 1 year reinfection incidence was 53.0% overall, and 62.3% among patients with complete 12 months of follow-up. Median time-to-reinfection was 3 months, with 84.2% involving the same pathogen as preoperatively. Most DLIs (88.5%) were polymicrobial. Common pathogens included coagulase-negative Staphylococci (59.0%), Staphylococcus aureus (54.1%), Corynebacterium spp (54.1%), Pseudomonas spp (23.0%), and Escherichia coli (21.3%). Preoperative bloodstream infections were present in 39.3%. Frequent reinfection recurrence was noted for all commonly isolated pathogens, except coagulase-negative Staphylococci. Complications occurred in 59.0%, mainly relaparotomy (41.7%), bleeding (33.3%), and impaired wound healing (35.0%). Postoperative 1 year survival was 78.3%. Freedom from 1 year reinfection showed a nonsignificant reduced hazard of death (hazard ratio [HR]: 0.57). Driveline relocation with OMW reduces the infection burden in a subset of patients. Given the procedure's substantial complication rate, it should be reserved as a last-resort therapy.