Correlation between driveline features and driveline infection in left ventricular assist device selection

Abstract

Although the survival rate for left ventricular assist device (LVAD) therapy has improved, device-related complications are an unpredictable threat to the patient's quality of life. We focused on driveline infection, and aimed to determine whether specific features of drivelines affect the frequency of infection. We enrolled patients who underwent LVAD implantation and were followed-up at our institute between 2007 and 2015. We counted the occurrences of driveline infection requiring any antibiotic therapy over a 2-year study period. Furthermore, we experimentally measured and compared the outer diameters and stiffness of three devices. Of all, 72 patients received an LVAD during the enrollment period. LVADs were HeartMate II (n = 32), EVAHEART (n = 22), and DuraHeart (n = 18). The outer diameters and stiffness were measured in five of each device. HeartMate II group had the highest driveline infection-free rate among all three devices during the study period (p = 0.042). The driveline of the HeartMate II LVAD had a significantly smaller outer diameter and lower stiffness than that of the other two devices (p < 0.05 for both). In conclusion, device-specific driveline features may affect the development of driveline infection during LVAD therapy.

Left ventricular assist device driveline infections in three contemporary devices

“…The HMII driveline had only 20%-25% of stiffness compared to other devices (EVAHEART and DuraHeart) and the highest driveline infection-free rate among those three devices. 22 In addition, the HMII driveline is only made of soft silicone, whereas the more rigid materials polyurethane + silicone used in the HM3 and the polyurethane material in the HVAD driveline potentially lead to more trauma and force applied to the driveline exit site during activities of daily living such as changing clothes, showering, changing bags, etc or unintentionally while sleeping or more generally through the behavior of each patient and the management of Despite the different relative risks for DLI readmission depending on the device, most likely due to device-specific driveline characteristics, the device type was not a significant risk factor for 2-year survival after HMII, HM3 or HVAD implantation (P = .26) (Table 5). Further investigations should be performed to investigate the influence of driveline materials and their mechanical properties as a risk factor for DLIs.…”

“…First, the HM3 has the largest driveline diameter of the outer (extracorporeal) pump cable (6.1 mm), compared to the HMII (5.7 mm) and HVAD (4.6 mm). Second, Imamura et al in 22 showed that driveline stiffness could be an important factor in the context of DLI. The HMII driveline had only 20%‐25% of stiffness compared to other devices (EVAHEART and DuraHeart) and the highest driveline infection‐free rate among those three devices 22 …”

“…Second, Imamura et al in 22 showed that driveline stiffness could be an important factor in the context of DLI. The HMII driveline had only 20%‐25% of stiffness compared to other devices (EVAHEART and DuraHeart) and the highest driveline infection‐free rate among those three devices 22 …”

Ventricular Assist Device-Specific Infections

“…HeartMate II VAD and HeartWare HVAD were parallel in developing driveline infections in the studies by Haglund et al, (2015) and Stulak et al, (2016) [ 15 , 26 ]; other studies reported a lower incidence of driveline infections in patients with a HeartWare HVAD relative to that with a HeartMate II VAD [ 36 , 85 , 86 ]. The difference in the incidence of driveline infections between VADs from different manufacturers is possibly due to their differences in driveline flexibility, cable diameters and other driveline characteristics such as biomaterials used for driveline manufacturing [ 36 , 87 ]. Smaller outer diameter and lower stiffness of drivelines have been associated with less driveline infections [ 87 ].…”

“…The difference in the incidence of driveline infections between VADs from different manufacturers is possibly due to their differences in driveline flexibility, cable diameters and other driveline characteristics such as biomaterials used for driveline manufacturing [ 36 , 87 ]. Smaller outer diameter and lower stiffness of drivelines have been associated with less driveline infections [ 87 ]. Though there is a lack of information in the literature comparing different materials of the drivelines as predictors of driveline infections, studies on other implantable medical devices such as central venous catheters found that the nature of the biomaterials was one of the key determinants of device-related infections [ 88 , 89 , 90 ].…”