Prevention, treatment and outcomes of left ventricular assist device driveline infections. A single Center experience.

INTRODUCTION

While the survival rates for patients with end-stage heart failure have dramatically improved with newer generations of left ventricular assist devices, LVAD-specific infections are important cause of morbidity, mortality, and hospital readmissions in these patients.

METHODS

We performed a retrospective analysis of all driveline infections in patients who had undergone LVAD implantation at a single cardiosurgical center. Between June 2013 and March 2017, 51 patients underwent implantation of LVAD. Among these, 12 received Heart Ware LVAD,34 Heart Mate II LVAD, and 5 Heart Mate III LVAD. The end goal for LVAD therapy was destination therapy in three patients and bridge-to-transplantation in 48 patients.

RESULTS

One month, six months, and one-year survival rates were 90%, 85%, and 81%, respectively. Five patients developed driveline infections. Median time from LVAD implantation to driveline infections was 126 days. One of these patients underwent heart transplantation. Two patients were treated with antibiotics and surgical driveline repositioning with extensive debridement of the wound. Two patients with a chronic infection were treated conservatively with regular wound cleaning.

CONCLUSION

Driveline infections remain a serious therapeutic challenge. With the development of surgical techniques and new devices, it is possible to reduce morbidity and increase survival rate in patients with implanted LVAD.

KEY WORDS

Driveline, Infections, LVAD.