Driveline damage and repair in continuous‐flow left ventricular assist devices: A systematic review

Abstract

With mounting time on continuous-flow left ventricular assist device (CF-LVAD) support, patients occasionally sustain damage to the device driveline. Outcomes associated with external and internal driveline damage and repair are currently not well documented. We sought to evaluate the outcomes of driveline damage and its repair. Electronic search was performed to identify all relevant studies published over the past 20 years. Fifteen studies were selected for analysis comprising of 55 patients with CF-LVAD dysfunction due to driveline damage. Demographic and perioperative variables along with outcomes including survival rates were extracted and pooled for the systematic review. Most patients (53/55) were supported on HeartMate II LVAD (Abbott Laboratories, Abbott Park, IL). Internal damage was more commonly reported than external damage [69.1% (38/55) vs. 30.9% (17/55), P = .01]. Median time to driveline damage was 1.9 years [IQR 1.0, 2.5]. Most patients presented with a CF-LVAD alarm [94.5% (52/55)] and patients with internal driveline damage had a significantly higher rate of alarm activation compared to that observed for those with external damage [38/38 (100%) vs. 14/17 (82.4%), P = .04]. Patients with internal driveline dysfunction were more likely to experience component wear compared to those with external driveline dysfunction [10/38 (26.3%) vs. 0/17 (0%), P = .05]; 14.5% of patients (8/55) underwent external repair of the driveline, 5.5% (3/55) were treated with rescue tape, and 5.5% (3/55) were placed on an ungrounded cable, indicating a short-to-shield event had occurred. A total of 49.1% of patients (27/55) underwent CF-LVAD exchange, 5.5% (3/55) were weaned off the CF-LVAD to explant, and 5.5% (3/55) underwent emergent heart transplantation. The median length of hospital stay was 12 days [IQR 7, 12] and 30-day mortality rate was 14.5% (8/55). Driveline damage was more commonly reported at an internal location and despite being a well-recognized complication, mortality still appears high. K E Y W O R D S continuous-flow left ventricular assist device driveline, device malfunction, driveline damage, driveline infection, driveline repair, heart transplant 820 | D'ANTONIO eT Al. Patient-level data were extracted from article texts, tables, and figures (ND, EM, and KP). Discrepancies between reviewer opinions were resolved by discussion and consensus. How to cite this article: D'Antonio ND, Maynes EJ, Tatum RT, et al. Driveline damage and repair in continuous-flow left ventricular assist devices: A systematic review.

Outcomes of modular cable exchange in HeartMate 3 patients versus conventional driveline repair in HeartMate II patients

“…If damages to the external driveline occur in older generation devices like the HeartMate II (Abbott Cooperation, U.S.A.), a specially trained company technician has to travel to the center and perform a repair—usually with the LVAD still running (Figure 1). 3,4 In worst scenarios, the driveline is so severely damaged that surgical LVAD exchange is the only curative option 5 …”

“…Especially in the increasing cohort of patients undergoing long-term therapy, damages to the external DL are a common complication of an active lifestyle since it is the most exposed part of the VAD to mechanical stress. [2][3][4] If damages to the external driveline occur in older generation devices like the HeartMate II (Abbott Cooperation, U.S.A.), a specially trained company technician has to travel to the center and perform a repairusually with the LVAD still running (Figure 1). 3,4 In worst scenarios, the driveline is so severely damaged that surgical LVAD exchange is the only curative option.…”

“…[2][3][4] If damages to the external driveline occur in older generation devices like the HeartMate II (Abbott Cooperation, U.S.A.), a specially trained company technician has to travel to the center and perform a repairusually with the LVAD still running (Figure 1). 3,4 In worst scenarios, the driveline is so severely damaged that surgical LVAD exchange is the only curative option. 5 The HeartMate 3 (HM3) (Abbott Cooperation, U.S.A.) left ventricular assist device (LVAD) was first implanted in the year of 2014 in Hannover by Prof. Schmitto and his team, showed promising results in the European CE mark trial as well as in the U.S. based MOMENTUM 3 study.…”