Ann Ital Chir. 2020;91:8-15.
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.
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.
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.
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.
Driveline, Infections, LVAD.
随着新一代左心室辅助装置的出现，晚期心力衰竭患者的生存率有了显著提高，但 LVAD 特有的感染仍是导致这些患者发病率、死亡率和住院再入院的重要原因。
我们对单一心脏外科中心接受 LVAD 植入的所有导线感染患者进行了回顾性分析。在 2013 年 6 月至 2017 年 3 月期间，51 名患者接受了 LVAD 植入。其中 12 例接受 Heart Ware LVAD，34 例接受 Heart Mate II LVAD，5 例接受 Heart Mate III LVAD。LVAD 治疗的最终目标是 3 例患者的终末期治疗和 48 例患者的桥接移植。
1 个月、6 个月和 1 年的生存率分别为 90%、85%和 81%。5 名患者发生了导线感染。从 LVAD 植入到导线感染的中位时间为 126 天。其中 1 例患者接受了心脏移植。2 例患者接受了抗生素治疗和手术导线重新定位，并对伤口进行了广泛清创。2 例慢性感染患者接受了常规伤口清洁的保守治疗。
导线感染仍然是一个严重的治疗挑战。随着手术技术和新设备的发展，有可能降低发病率并提高植入 LVAD 的患者的生存率。
导线、感染、LVAD。
