Saricaoglu Mehmet Cahit, Kandemir Melisa, Saricaoglu Elif M, Karacuha Ali Fuat, Kadiroglu Ezel, Abdullahi Mustafa Farah, Inan Mustafa Bahadir, Azap Alpay, Akar Ahmet Ruchan
Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, Ankara 06340, Turkey.
Department of Infectious Disease and Clinical Microbiology, Ibni Sina Hospital, Ankara University School of Medicine, Ankara 06340, Turkey.
J Cardiovasc Dev Dis. 2025 Jun 3;12(6):211. doi: 10.3390/jcdd12060211.
Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs and discuss the surgical treatment modalities.
We retrospectively reviewed 90 patients who underwent a left or biventricular ventricular assist device (LVAD or BiVAD) implantation with either a HeartMate 2 (Abbott), HeartWare HVAD (Medtronic), or HeartMate 3 (Abbott) in a single center between 1 March 2011 and 30 May 2023.
DLIs were detected in 20 (21.5%) patients during the follow-up. The mean duration of VAD support was 561.1 ± 833.2 days (1-4124 days), while it was 1277.9 ± 621.6 days in the DLI group. An extended duration of VAD support was associated with higher incidence rates of late-onset DLIs ( < 0.05). A younger age and lower plasma albumin levels were independent predictive factors for the risk of a DLI, with a hazard ratio of 9.77 (95%CI: 1.3-74.5) and 10.55 (95%CI: 1.40-79.35), respectively. The removal of the biofilm with velour and DL relocation through the rectus muscle combined with vacuum-assisted strategies (VAC) were performed in nine patients. One patient developed a recurrent infection, and another patient with a deep DLI subsequently received a heart transplant. No patient underwent a device exchange for an intractable DLI.
Our results suggest that DLIs are common infectious complications after VAD implantation, which endanger patient autonomy, and impair their quality of life and overall survival. A DL relocation through the rectus muscles and VAC strategies have a role in controlling DLIs.
持久的机械循环支持（DMCS）感染仍然是一个严峻的挑战。心室辅助装置（VAD）特定的驱动线感染（DLI）是最常见的类型；然而，关于其外科治疗尚无共识。我们旨在确定DLI的发病率、危险因素和微生物学，并讨论外科治疗方式。
我们回顾性分析了2011年3月1日至2023年5月30日期间在单一中心接受左心室或双心室心室辅助装置（LVAD或BiVAD）植入的90例患者，所用装置为HeartMate 2（雅培）、HeartWare HVAD（美敦力）或HeartMate 3（雅培）。
随访期间，20例（21.5%）患者检测到DLI。VAD支持的平均持续时间为561.1±833.2天（1 - 4124天），而DLI组为1277.9±621.6天。VAD支持时间延长与迟发性DLI的较高发病率相关（<0.05）。年龄较小和血浆白蛋白水平较低是DLI风险的独立预测因素，风险比分别为9.77（95%CI：1.3 - 74.5）和10.55（95%CI：1.40 - 79.35）。9例患者采用含绒布的生物膜清除术及通过腹直肌进行驱动线重新定位并结合负压辅助策略（VAC）。1例患者发生复发性感染，另1例深部DLI患者随后接受了心脏移植。没有患者因难治性DLI进行装置更换。
我们的结果表明，DLI是VAD植入后常见的感染并发症，危及患者自主性，损害其生活质量和总体生存。通过腹直肌进行驱动线重新定位和VAC策略在控制DLI方面具有作用。
