Double tunnel technique for the LVAD driveline: improved management regarding driveline infections

Abstract

A driveline exit site infection is a serious and common complication in long-term left ventricular assist device (LVAD) support. To reduce the incidence and severity of late driveline infections, we modified our surgical technique (double tunnel), and compared it to the conventional short and straight driveline tunnel technique (conventional). We analyzed 43 consecutive patients (37 HeartMate II; 6 Ventrassist) regarding late onset driveline exit site infections after using the surgical driveline tunnel technique after successful LVAD implantation. Of these 43 patients, 11 were treated with the conventional short and straight driveline tunnel technique (conventional), while 32 patients were treated with the modified long subfascial, C-shaped technique (double tunnel). We observed slightly fewer superficial driveline exit site infections in the double tunnel group, even though the difference was not statistically significant (0.638 vs. 1.148 infections/1,000 patient-days; P = 0.22). There were also insignificantly fewer surgical interventions because of exit site infections in the double tunnel group (0.159 vs. 0.581 revisions/1,000 patient-days; P = 0.18). The double tunnel technique offers more surgical options in the case of driveline exit site infections. Due to the long subfascial tunnel, the infected site can be separated from the new driveline exit site, and vacuum-assisted closure therapy can be applied to the infected area. In conclusion, we recommend using the double tunnel driveline technique because of the low infection rate and better treatment options in the case of driveline exit site infection.

Reduction of Driveline Infections Through Doubled Driveline Tunneling of Left Ventricular Assist Devices

“…Our results are in line with a small case series that also found a reduction in driveline infections using a similar double tunnel technique . The identification of risk factors in this heterogeneous and severely ill patient population remains a challenge.…”

A Review of Infections in Patients with Left Ventricular Assist Devices: Prevention, Diagnosis and Management

“…19 Surgical techniques such as increasing intrafascial tunneling of the driveline may help reduce infections. 20,21 Additionally, externalization of the silicone portion of the driveline (as opposed to the velour portion) also decreases infections.…”

Single versus multi‐drug antimicrobial surgical infection prophylaxis for left ventricular assist devices: A systematic review and meta‐analysis

“…There are four main determinants for LVAD infection defined by Pereda and Conte which include (a) microbial determinants; (b) patient‐related factors, such as increased body mass index (BMI), diabetes, poor preoperative health, renal failure, number of access lines and immunosuppression; (c) characteristics of the device which include the surgical technique of driveline tunneling and externalization, pump placement location as well as (d) perioperative interventions including prophylactic antibiotics, patient education, and prevention of driveline trauma …”

“…There are four main determinants for LVAD infection defined by Pereda and Conte 9 which include (a) microbial determinants; (b) patient-related factors, such as increased body mass index (BMI), 10,11 diabetes, 12 poor preoperative health, 13 renal failure, 9 number of access lines and immunosuppression 5 ; (c) characteristics of the device which include the surgical technique of driveline tunneling and externalization, 10,14,15 pump placement location [16][17][18] as well as (d) perioperative interventions including prophylactic antibiotics, 19,20 patient education, 21 and prevention of driveline trauma. 9 Despite infections being a major complication of LVAD therapy, the incidence of LVAD infections has often not been discussed sufficiently in the past, and there remains a lack of standardization in the use of surgical infection prophylaxis regimens among patients with LVADs.…”