Management of chronic left ventricular assist device percutaneous lead insertion sites

Patients with ventricular assist devices must necessarily have percutaneous leads linking the internal device to the external console. In the chronic circumstance, the percutaneous lead insertion site may become the location of irritation or infection. At the University of Pittsburgh, a procedure has been developed for care of this site. Since the institution of the procedure, 30 patients have been mechanically supported, representing a total of 1688 patient days of support. Positive cultures were obtained from the lead insertion sites of four patients in this series, whose length of support ranged from 72 to 144 days. All four patients were hemodynamically unstable requiring support with the intraaortic balloon pump before institution of the ventricular assist device, and two patients had significant risk factors for infection development at the lead insertion site before implementation. Two of the infections were considered minor, and posttransplantation sequelae developed in only one patient. With current therapeutic protocols and the defined procedure for care of the lead insertion site, the occurrence of positive cultures associated with clinical signs and symptoms of site infection appears to be infrequent.