Ventricular Assist Device Driveline Infections: A Systematic Review

Abstract

Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients.

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

“…Some examples of patient characteristics that increase the risk of driveline infections are obesity, younger age, worse constitution, and longer time on device support [ 69 ]. Co-morbidities like diabetes, chronic kidney disease, and depression have also been associated with higher risk of driveline infection [ 69 ].…”

“…Some examples of patient characteristics that increase the risk of driveline infections are obesity, younger age, worse constitution, and longer time on device support [ 69 ]. Co-morbidities like diabetes, chronic kidney disease, and depression have also been associated with higher risk of driveline infection [ 69 ]. A single-center analysis showed that driveline infections are more common among HM3 patients, possibly due to the bigger size of the driveline in this device [ 70 ].…”

“…Strategies to prevent driveline infections include ensuring that the velour part of the driveline is entirely within the tissue tunnel, using fixation anchors to maintain optimal driveline position, having a standardized dressing change protocol with strict sterile technique, and patient education [ 69 ].…”

Bacteriophage-Enriched Galenic for Intrapericardial Ventricular Assist Device Infection

“…However, donor organ availability is strongly limited, and there is a growing number of destination therapy patients who will require alternative treatment in case of device infection [4]. This is particularly important, as otherwise established strategies such as antibiotic treatment or negative pressure wound therapy alone have not been able to provide an effective solution for device-related infections [5]. Lately, the rediscovery of bacteriophage therapy for the treatment of complex surgical infections has enabled a stimulating and novel, yet poorly investigated, option for VAD patients with device-related infections [6][7][8][9].…”

Decreasing driveline infections in patients supported on ventricular assist devices: a care pathway approach

“…To circumvent this, ventricular assist devices (VADs) can serve as a bridge to transplantation (BTT) or as destination therapy in this patient population 2–5. Yet, VAD support is not without its complications, with driveline infections (DLIs) being among the most commonly reported adverse event 6–11…”