LVAD power delivery: a percutaneous approach to avoid infection

Area of Science:

• Biomedical Engineering
• Cardiovascular Surgery
• Infectious Disease Prevention

Background:

• Driveline infections are a major complication for patients with left ventricular assist devices (LVADs), impacting their survival.
• Reducing driveline complications is crucial for improving LVAD therapy, especially for bridge-to-transplantation or recovery.

Purpose of the Study:

• To develop and evaluate a novel pedestal design to minimize percutaneous driveline infections in LVAD patients.
• To assess the efficacy of a skull-mounted pedestal compared to a shoulder-mounted one in a preclinical model.

Main Methods:

• A carbon and later titanium pedestal was designed to route electric wires through the skin in a sheep model.
• Pedestals were implanted in the shoulder (n=10) or scalp with skull fixation (n=9), with exit wounds monitored for infection and healing.
• Power cable durability was tested in 6 additional animals without implanted pumps.

Main Results:

• Skull-mounted pedestals showed no infection or healing issues over a cumulative 1,491 days.
• Shoulder-mounted pedestals in mobile tissues resulted in infection (n=2) and impaired healing (n=5).
• Electric cables demonstrated durability during repeated neck flexion, and titanium pedestals proved more robust than carbon ones.

Conclusions:

• Rigid fixation combined with highly vascularized scalp skin effectively reduces percutaneous driveline infections.
• This novel pedestal design offers a potential solution to a significant challenge in long-term LVAD therapy.