Schibilsky David, Benk Christoph, Haller Christoph, Berchtold-Herz Michael, Siepe Matthias, Beyersdorf Friedhelm, Schlensak Christian
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
J Artif Organs. 2012 Mar;15(1):44-8. doi: 10.1007/s10047-011-0607-3. Epub 2011 Oct 11.
A driveline exit site infection is a serious and common complication in long-term left ventricular assist device (LVAD) support. To reduce the incidence and severity of late driveline infections, we modified our surgical technique (double tunnel), and compared it to the conventional short and straight driveline tunnel technique (conventional). We analyzed 43 consecutive patients (37 HeartMate II; 6 Ventrassist) regarding late onset driveline exit site infections after using the surgical driveline tunnel technique after successful LVAD implantation. Of these 43 patients, 11 were treated with the conventional short and straight driveline tunnel technique (conventional), while 32 patients were treated with the modified long subfascial, C-shaped technique (double tunnel). We observed slightly fewer superficial driveline exit site infections in the double tunnel group, even though the difference was not statistically significant (0.638 vs. 1.148 infections/1,000 patient-days; P = 0.22). There were also insignificantly fewer surgical interventions because of exit site infections in the double tunnel group (0.159 vs. 0.581 revisions/1,000 patient-days; P = 0.18). The double tunnel technique offers more surgical options in the case of driveline exit site infections. Due to the long subfascial tunnel, the infected site can be separated from the new driveline exit site, and vacuum-assisted closure therapy can be applied to the infected area. In conclusion, we recommend using the double tunnel driveline technique because of the low infection rate and better treatment options in the case of driveline exit site infection.
在长期左心室辅助装置（LVAD）支持过程中，驱动线出口部位感染是一种严重且常见的并发症。为降低晚期驱动线感染的发生率和严重程度，我们改进了手术技术（双隧道技术），并将其与传统的短直驱动线隧道技术（传统技术）进行比较。我们分析了43例连续患者（37例使用HeartMate II；6例使用Ventrassist），这些患者在成功植入LVAD后采用手术驱动线隧道技术，观察晚期驱动线出口部位感染情况。在这43例患者中，11例采用传统的短直驱动线隧道技术（传统技术）治疗，而32例患者采用改良的长皮下C形技术（双隧道技术）治疗。我们观察到双隧道组的表浅驱动线出口部位感染略少，尽管差异无统计学意义（0.638比1.148例感染/1000患者日；P = 0.22）。双隧道组因出口部位感染进行的手术干预也略少，差异无统计学意义（0.159比0.581次翻修/1000患者日；P = 0.18）。在驱动线出口部位感染的情况下，双隧道技术提供了更多的手术选择。由于长皮下隧道，感染部位可与新的驱动线出口部位分离，并且可对感染区域应用负压封闭引流治疗。总之，由于感染率低且在驱动线出口部位感染时治疗选择更好，我们推荐使用双隧道驱动线技术。
