Imaoka Shusuke, Kashiyama Noriyuki, Yoshioka Daisuke, Saito Shunsuke, Kawamura Takuji, Kawamura Ai, Matsuura Ryohei, Misumi Yusuke, Toda Koichi, Miyagawa Shigeru
Departments of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita Shi, Osaka, Osaka fu, 565-0871, Japan.
Departments of Cardiovascular Surgery, Fukui Cardiovascular Hospital, Fukui, Japan.
J Artif Organs. 2025 Jun;28(2):207-215. doi: 10.1007/s10047-024-01482-8. Epub 2024 Dec 18.
Left ventricular assist devices (LVADs) are implanted in patients with heart failure to support cardiac circulation. However, no standardized methods have been established for LVAD driveline exit site management for the prevention of infections. Therefore, this study evaluated the efficacy of modified driveline management compared with that of conventional driveline management. We retrospectively assessed the outcomes of 262 patients who underwent continuous-flow LVAD implantation between January 2005 and March 2023 at Osaka University in Japan. In conventional driveline management, an LVAD driveline penetrates the skin along the body surface and is fixed near the penetration site (n = 224). In contrast, in our modified fixation method, the LVAD driveline vertically penetrates the skin to prevent ischemia at the driveline exit site and is fixed at a distant abdominal site to prevent the movement of the driveline exit site due to body movement (n = 38). The rates of freedom from LVAD driveline infection in patients with conventional driveline management were 86, 75, and 63% at 1, 2, and 3 years after LVAD implantation, respectively. The rate of freedom from LVAD driveline infection in patients managed by the modified fixation method was 91% at 1, 2, as well as 3 years after LVAD implantation. The freedom rates from LVAD driveline infection in the patients with modified fixation method was lower than in the patients with the conventional method (p = 0.04). Our study revealed that the modified fixation method may offer the possibility for preventing LVAD driveline infection.
左心室辅助装置（LVAD）被植入心力衰竭患者体内以支持心脏循环。然而，尚未建立用于LVAD驱动线出口部位管理以预防感染的标准化方法。因此，本研究评估了改良驱动线管理与传统驱动线管理相比的疗效。我们回顾性评估了2005年1月至2023年3月在日本大阪大学接受连续流LVAD植入的262例患者的结局。在传统驱动线管理中，LVAD驱动线沿体表穿透皮肤并固定在穿透部位附近（n = 224）。相比之下，在我们的改良固定方法中，LVAD驱动线垂直穿透皮肤以防止驱动线出口部位缺血，并固定在腹部远处部位以防止由于身体运动导致驱动线出口部位移动（n = 38）。传统驱动线管理患者在LVAD植入后1、2和3年的LVAD驱动线无感染率分别为86%、75%和63%。采用改良固定方法管理的患者在LVAD植入后1、2和3年的LVAD驱动线无感染率为91%。改良固定方法患者的LVAD驱动线无感染率低于传统方法患者（p = 0.04）。我们的研究表明，改良固定方法可能为预防LVAD驱动线感染提供可能性。
