Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Artif Organs. 2013 Jan;37(1):102-7. doi: 10.1111/aor.12036.
The durability of ventricular assist device (VAD) therapy improved steadily over the past years. However, driveline infections remain a challenge. To test whether an improved surgical implantation technique may lower the incidence of infections, we analyzed all patients receiving a VAD implantation in the years 2008 and 2009 (group 1) and compared them with all patients who received a VAD in 2011 (group 2) after we changed our implantation method. The new technique involves tunneling of the driveline into the fascia of the musculus rectus abdominis, resulting in a longer, intrafascial run to achieve a better resistance against ascending infections. We retrospectively analyzed 40 patients in group 1 and 41 patients in group 2. One year after implantation, the infection rate was markedly reduced (22.5% [n = 9] group 1 vs. 4.9% [n = 2] group 2, P < 0.001) by the new implantation method. There was, however, no significant improvement in overall mortality. The Cox regression model identified the implantation method as an independent risk factor for 1 year after implantation driveline infection (P < 0.05). In conclusion, the new tunneling technique marks a great leap forward in long-term VAD treatment. However, overall mortality remains high and needs further improvement.
心室辅助装置 (VAD) 治疗的耐久性在过去几年中稳步提高。然而，驱动线感染仍然是一个挑战。为了测试改进的手术植入技术是否可以降低感染的发生率，我们分析了 2008 年和 2009 年（第 1 组）所有接受 VAD 植入的患者，并将他们与 2011 年（第 2 组）在改变植入方法后接受 VAD 植入的所有患者进行比较。新技术涉及将驱动线隧道至腹直肌筋膜内，从而使驱动线在筋膜内的运行更长，以更好地抵抗上行感染。我们回顾性分析了第 1 组的 40 例患者和第 2 组的 41 例患者。植入后 1 年，感染率显著降低（第 1 组为 22.5%[n=9]，第 2 组为 4.9%[n=2]，P<0.001），采用新的植入方法。然而，总体死亡率并没有显著改善。Cox 回归模型确定植入方法是植入后 1 年发生驱动线感染的独立危险因素（P<0.05）。总之，新的隧道技术标志着 VAD 治疗的一个重大飞跃。然而，总体死亡率仍然很高，需要进一步改善。
