Balsam Leora B, Jacoby Adam, Louie Eddie, Levine Jamie P
Innovations (Phila). 2017 Nov/Dec;12(6):440-445. doi: 10.1097/IMI.0000000000000433.
Driveline infection is a common complication of durable left ventricular assist device support. The majority involve the driveline exit site and can be treated with antibiotics and local wound care. Less frequently, these infections extend into deeper tissues and surgical debridement is necessary. Few studies have described the surgical strategy for treatment of deep driveline infection or have reported long-term outcomes. With a growing population of patients being implanted as destination therapy, there is an obvious need to evaluate and optimize treatment for complex driveline infections.
Outcomes of patients undergoing durable left ventricular assist device implantation at a single center between 2011 and 2017 were reviewed retrospectively. Data including occurrence of driveline infection, pathogen, time to driveline infection, and treatment strategy were abstracted from the electronic medical record.
Driveline infection occurred in 10 (16.4%) of 61 patients at a median of 362 days (Q1 = 99, Q3 = 694) after primary left ventricular assist device implantation. Three (30.0%) of 10 driveline infections were categorized as deep and did not resolve with intravenous antibiotic therapy. In these cases, a multistage approach that included initial debridement and exteriorization of the infected driveline, followed by delayed surgical relocation of the driveline in a clean vascularized soft tissue bed, was used. Long-term device salvage was achieved in all cases.
An aggressive surgical strategy, including debridement and formal relocation of the driveline exit site, can result in long-term device salvage after deep driveline infection. This approach is a less invasive alternative to device exchange for refractory driveline infections.
驱动线感染是长期左心室辅助装置支持常见的并发症。大多数感染累及驱动线出口部位，可通过抗生素和局部伤口护理进行治疗。较少见的情况是，这些感染会蔓延至更深层组织，需要进行手术清创。很少有研究描述深部驱动线感染的手术治疗策略或报告长期预后。随着作为终末期治疗而植入装置的患者数量不断增加，显然需要评估和优化对复杂驱动线感染的治疗。
回顾性分析2011年至2017年在单一中心接受长期左心室辅助装置植入患者的预后。从电子病历中提取包括驱动线感染的发生情况、病原体、发生驱动线感染的时间以及治疗策略等数据。
61例患者中有10例（16.4%）发生驱动线感染，初次左心室辅助装置植入后中位时间为362天（第一四分位数 = 99，第三四分位数 = 694）。10例驱动线感染中有3例（30.0%）被归类为深部感染，静脉使用抗生素治疗无效。在这些病例中，采用了多阶段方法，包括最初对感染的驱动线进行清创和外置，随后在清洁的血管化软组织床中延迟进行驱动线的手术重新安置。所有病例均实现了长期装置挽救。
积极的手术策略，包括对驱动线出口部位进行清创和正式重新安置，可在深部驱动线感染后实现长期装置挽救。对于难治性驱动线感染，这种方法是一种侵入性较小的装置更换替代方案。
