Surgical management of driveline infections in patients with left ventricular assist devices

Abstract

Driveline relocation with use of omentum is a feasible and effective procedure in selected cases of chronic severe driveline infection. The risk for perioperative bleeding should be taken into consideration and carefully monitored.

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

“…Although we used our institution's algorithm for surgical treatment, other novel surgical techniques for managing infections in these patients have been described. Of note, Pieri et al reported a technique of translocation and omental wrapping for severe chronic driveline infections . Jacoby et al described flap coverage for treating exposed LVAD hardware and intractable LVAD infections .…”

Flap coverage for the treatment of exposed left ventricular assist device (LVAD) hardware and intractable LVAD infections

“…In such cases, repositioning of the driveline exit site and rectus flaps may not be feasible. Alternatively, pedicled omentum can be used for coverage . In the event of device endocarditis, device explantation may be necessary for source control.…”

“…However, if the device remains exposed after debridement, coverage with well‐vascularized, healthy tissue is necessary for definitive infection management. We and others have described coverage options for exposed devices . Given its proximity to LVAD hardware and generous pedicle length, the rectus abdominis myocutaneous flap is the most commonly used flap for device coverage.…”

“…However, the rectus muscle flap may not be available for coverage as it may be cut during device implantation or be debrided for infection control. In such cases, vascularized omental flaps and local perforator flaps have been reported as viable alternatives . We report our experience with flap salvage of infected and/or exposed LVAD hardware and discuss the management of refractory, indolent infections.…”

Device exchange versus nonexchange modalities in left ventricular assist device‐specific infections: A systematic review and meta‐analysis

“…Conventionally, antibiotics and minor debridement procedures were used to manage minor driveline infections, whereas exchange and transplantation were used to manage severe or recurrent pump and pump pocket infections (5). In cases where operative debridement leaves a defect, closure can be done with rectus muscle or omental flaps (7)(8)(9)(10).…”