Driveline Site Is Not a Predictor of Infection After Ventricular Assist Device Implantation

Abstract

Driveline infections (DLIs) remain a major source of morbidity for patients requiring long-term ventricular assist device (VAD) support. We aimed to assess whether VAD driveline exit site (DLES) (abdomen versus chest wall) is associated with DLI. All adult patients who underwent insertion of a HeartWare HVAD or HeartMate II (HMII) between 2009 and 2016 were included. Driveline infection was defined as clinical evidence of DLI accompanied by a positive bacterial swab and need for antibiotics. Competing risks analysis was used to assess the association between patient characteristics and DLI. Ninety-two devices (59 HMII) were implanted in 85 patients (72 men; median age 57.4 years) for bridge to transplant or destination therapy. VAD DLES was chest in 28 (30.4%) devices. Median time on VAD support was 347.5 days (IQR 145.5, 757.5), with 28 transplants and 29 deaths (27 on device). DLI occurred in 24 patients (25 devices) at a median of 140 days (IQR 67, 314) from implant. Staphylococcus aureus accounted for 15 infections (60%). Freedom from infection was 72.8% (95% confidence interval [CI] 53.1-78.0%) at 1 year and 41.9% (95% CI 21.1-61.5%) at 3 years. In competing risks regression, abdominal DLES was not predictive of DLI (hazard ratio, HR 1.65 [95% CI 0.63, 4.29]), but body mass index (BMI) >30 kg/m was (HR 2.72 [95% CI 1.25, 5.92]). In conclusion, risk of DLI is high among patients on long-term VAD support, and a nonabdominal DLES does not reduce this risk. The only predictor of DLI in this series was an elevated BMI.

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.…”

Update on Stem Cell‐Based Therapy and Mechanical Cardiac Support: A North American Perspective

“…Given the shortage of donor hearts, mechanical circulatory support has been increasingly utilized for long‐term support with survival approaching that of orthotopic heart transplantation . Mechanical circulatory support, however, comes with the inherent risk of adverse events such as infection , stroke , bleeding , thrombosis , or device malfunction . As such, a method to achieve ventricular recovery is desirable.…”

Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis

“…Blood pumps or continuous‐flow left ventricular assist devices (CF‐LVADs), either in the form of implantable or extracorporeal devices, have emerged as a promising therapeutic alternative for end‐stage heart failure . With growing utilization of CF‐LVADs for end‐stage heart failure, adverse events remain common leading to significant patient morbidity and mortality . One such major complication is pump thrombosis.…”

“…3,[8][9][10] With growing utilization of CF-LVADs for end-stage heart failure, adverse events remain common leading to significant patient morbidity and mortality. [11][12][13][14][15][16][17][18][19][20] One such major complication is pump thrombosis. The incidence of pump thrombosis has been estimated to be between 1.4% and 13.9%, and is largely dependent on the device.…”