Internal driveline damage under the costal margin several years after HeartMate II implant: a series of three cases

Abstract

Although the incidence of driveline failure has been significantly reduced with the major modification to the driveline connection to the HeartMate II left ventricular assist device (LVAD), internal and external driveline damage continues to be a major reason for pump exchange or driveline repair. We report three cases of internal driveline damage under the costal margin and in the adjacent abdominal wall. All three cases developed occasional electrical disruptions 2-5 years after the original LVAD implant through the median sternotomy. Two patients underwent subcostal LVAD exchange and one had driveline externalization and repair. The driveline velour was well adhered to the costal margin and wire damage was found at the costal margin as well as the subsequent segment in the abdominal wall. Repeated ante-flex bending of the abdominal wall over years appeared to cause the chronic wear and tear of the vertically located driveline under the costal margin. This report will confirm a pitfall of the LVAD driveline location which can potentially cause driveline damage in the mid-to-long term.

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

“…The authors documented a transection of the driveline which led to complete electrical breakage of the system, sending the patient into cardiac arrest. Specific movement can also cause damage, particularly repeated ante‐flex bending of the abdominal wall 15 . Since wear and tear owing to the vulnerability of the wire appears to be a major issue, patients who are either more active or are predisposed to damage due to obesity or movement disorders will need to be managed with extra precautions.…”

“…Specific movement can also cause damage, particularly repeated ante-flex bending of the abdominal wall. 15 Since wear and tear owing to the vulnerability of the wire appears to be a major issue, patients who are either more active or are predisposed to damage due to obesity or movement disorders will need to be managed with extra precautions. In one case, driveline fracture occurred due to repeated falls in a patient with Becker muscular dystrophy, 16 highlighting the need for more patient-specific management approaches.…”

Left ventricular assist devices exchange: why, when and how to do it—experience from experts

“…If only technical reasons are considered, the device malfunction rate reaches about 0.9 to 5.8 percent of patients on support (9)(10)(11). Malfunction can be caused Editorial Left ventricular assist devices exchange: why, when and how to do it-experience from experts by a failure of the inner electrical component of the pump or the integrated driveline, especially if the damage/failure (e.g., cable fracture or unintentional damage by sharp objects) of the driveline is located very close to the exit site, a phenomenon called "short to shield" meaning the repair of the driveline is impossible or not safe (12,13).…”