Fudim Marat, Brown Christopher L, Davis Mary E, Djunaidi Monica, Danter Matthew R, Harrell Frank E, Stulak John M, Haglund Nicholas A, Maltais Simon
From the *Cardiovascular Medicine, Vanderbilt School of Medicine, Nashville, Tennessee; †Vanderbilt University Medical Center, Nashville, Tennessee; ‡Cardiac Surgery, §Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; and ¶Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
ASAIO J. 2016 May-Jun;62(3):291-6. doi: 10.1097/MAT.0000000000000346.
Driveline infections (DLI) are a cause of morbidity after continuous-flow left ventricular assist device (CF-LVAD) implantation. Because driveline trauma contributes to DLI, we assessed whether intraoperative placement of a temporary external anchoring suture (EAS) influenced DLI rate. We analyzed 161 consecutive patients with CF-LVAD (HMII 82; HW 79) implantation. Two groups were defined: placement of EAS (n = 85) or No EAS (n = 76). For NO EAS patients, the driveline was permanently anchored internally to the rectus fascia. Cox proportional analysis was performed to assess the effect of EAS on time to first confirmed DLI. Baseline characteristics were comparable between groups (all p = 0.3). Mean follow-up time was 0.93 years. A total of 18 (11.1%) patients developed confirmed culture positive DLI, with "first infection" rate of 0.13 events/year. Mean time to confirmed DLI was 0.69 years. Driveline infection was less likely (hazard ratio [HR] = 0.28, 0.95 confidence interval [CI] = 0.06-1.25, p = 0.056) to occur in NO EAS (2/18) then in EAS (16/18). Confirmed DLI was comparable between device types (p = 0.3). Multivariable regression adjusted for age, BMI, blood product use, device type, and diabetes showed equivocal effect of EAS (HR = 0.33, 0.95 CI = 0.07-1.54, p = 0.12). Patients with a temporary EAS may have an increased risk of confirmed DLI after device implantation.
在连续流左心室辅助装置（CF-LVAD）植入后，经皮导线感染（DLI）是发病的一个原因。由于经皮导线创伤会导致DLI，我们评估了术中放置临时外部锚定缝线（EAS）是否会影响DLI发生率。我们分析了161例连续植入CF-LVAD（HeartMate II 82例；HeartWare 79例）的患者。定义了两组：放置EAS组（n = 85）和未放置EAS组（n = 76）。对于未放置EAS的患者，经皮导线永久地在内部固定于腹直肌筋膜。进行Cox比例分析以评估EAS对首次确诊DLI时间的影响。两组间基线特征具有可比性（所有p = 0.3）。平均随访时间为0.93年。共有18例（11.1%）患者发生确诊的培养阳性DLI，“首次感染”率为0.13次事件/年。确诊DLI的平均时间为0.69年。未放置EAS组（2/18）发生经皮导线感染的可能性低于放置EAS组（16/18）（风险比[HR] = 0.28，95%置信区间[CI] = 0.06 - 1.25，p = 0.056）。不同装置类型之间确诊的DLI具有可比性（p = 0.3）。对年龄、体重指数、血液制品使用、装置类型和糖尿病进行多变量回归调整后，EAS的影响不明确（HR = 0.33，95%CI = 0.07 - 1.54，p = 0.12）。植入临时EAS的患者在装置植入后确诊DLI的风险可能增加。
