From the Division of Cardiothoracic Surgery, Stanford University, Stanford, California.
Division of Cardiac Surgery, University of Alberta, Edmonton, Canada.
ASAIO J. 2018 Sep/Oct;64(5):616-622. doi: 10.1097/MAT.0000000000000690.
Driveline infections (DLIs) remain a major source of morbidity for patients requiring long-term ventricular assist device (VAD) support. We aimed to assess whether VAD driveline exit site (DLES) (abdomen versus chest wall) is associated with DLI. All adult patients who underwent insertion of a HeartWare HVAD or HeartMate II (HMII) between 2009 and 2016 were included. Driveline infection was defined as clinical evidence of DLI accompanied by a positive bacterial swab and need for antibiotics. Competing risks analysis was used to assess the association between patient characteristics and DLI. Ninety-two devices (59 HMII) were implanted in 85 patients (72 men; median age 57.4 years) for bridge to transplant or destination therapy. VAD DLES was chest in 28 (30.4%) devices. Median time on VAD support was 347.5 days (IQR 145.5, 757.5), with 28 transplants and 29 deaths (27 on device). DLI occurred in 24 patients (25 devices) at a median of 140 days (IQR 67, 314) from implant. Staphylococcus aureus accounted for 15 infections (60%). Freedom from infection was 72.8% (95% confidence interval [CI] 53.1-78.0%) at 1 year and 41.9% (95% CI 21.1-61.5%) at 3 years. In competing risks regression, abdominal DLES was not predictive of DLI (hazard ratio, HR 1.65 [95% CI 0.63, 4.29]), but body mass index (BMI) >30 kg/m was (HR 2.72 [95% CI 1.25, 5.92]). In conclusion, risk of DLI is high among patients on long-term VAD support, and a nonabdominal DLES does not reduce this risk. The only predictor of DLI in this series was an elevated BMI.
移植物血管通道感染（DLI）仍然是需要长期心室辅助装置（VAD）支持的患者发病的主要原因。我们旨在评估 VAD 移植物血管通道出口部位（DLES）（腹部与胸壁）是否与 DLI 相关。所有 2009 年至 2016 年间接受 HeartWare HVAD 或 HeartMate II（HMII）植入的成年患者均纳入研究。DLI 的定义为伴有阳性细菌拭子和需要抗生素的 DLI 的临床证据。使用竞争风险分析来评估患者特征与 DLI 之间的关联。85 名患者（72 名男性；中位年龄 57.4 岁）共植入 92 个装置（59 个 HMII），用于桥接移植或作为终末期心力衰竭的治疗方法。28 个装置的 VAD DLES 在胸部。中位 VAD 支持时间为 347.5 天（IQR 145.5，757.5），有 28 例移植和 29 例死亡（27 例在装置上）。24 名患者（25 个装置）在植入后中位 140 天（IQR 67，314）发生 DLI。金黄色葡萄球菌引起 15 例感染（60%）。感染无复发率在 1 年时为 72.8%（95%CI 53.1-78.0%），在 3 年时为 41.9%（95%CI 21.1-61.5%）。在竞争风险回归中，腹部 DLES 与 DLI 无相关性（风险比，HR 1.65[95%CI 0.63，4.29]），但 BMI＞30kg/m 时为（HR 2.72[95%CI 1.25，5.92]）。总之，长期 VAD 支持的患者发生 DLI 的风险较高，而非腹部 DLES 并不能降低这种风险。本系列中 DLI 的唯一预测因子是升高的 BMI。
