Special Treatment and Wound Care of the Driveline Exit Site after Left Ventricular Assist Device Implantation

Abstract

Objective Despite good results following implantation of left ventricular assist devices (LVADs), infections of the driveline and device pocket remain a major problem for patients on long-term support. We present the data from heart failure patients treated with a Thoratec HeartMate-II LVAD (Thoratec Corporation, Pleasanton, California, United States).

Methods From January 2008 to April 2011, in our institution, 40 heart failure patients (NYHA IV) were supported with a HeartMate-II LVAD. The driveline maintenance of 17 patients consisted of the use of Octenidine for the wound dressing, whereas merbromin was additionally used for local irrigation in 31 patients. The data concerning driveline infections were analyzed retrospectively.

Results In our study, 95% of the entire cohort was free from infections of the system. Two patients in the conventional group (11.8%) developed a driveline infection at a mean of 130.5 days during 3,416 patient-days (0.21 infection/patient-years). In the Merbromid group (Co. New FaDem SRL Farmaceutici & Chimici, Giugliano, Campania, Italy), all patients were free from any driveline infections during the observation period. In a log-rank comparison, the difference reached statistical significance (p = 0.043).

Conclusion During our observation period, fewer infections were noted with merbromin treatment. A multicenter setting in a larger cohort should be performed to confirm these findings, although a (double-) blinded setting might be difficult to achieve.

Keywords

heart failure - left ventricular assist device - infections

• References

• 1 Frazier OH, Rose EA, Oz MC , et al; HeartMate LVAS Investigators. Left Ventricular Assist System. Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg 2001; 122 (6) 1186-1195
• 2 Rogers JG, Aaronson KD, Boyle AJ , et al; HeartMate II Investigators. Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. J Am Coll Cardiol 2010; 55 (17) 1826-1834
• 3 Park SJ, Tector A, Piccioni W , et al. Left ventricular assist devices as destination therapy: a new look at survival. J Thorac Cardiovasc Surg 2005; 129 (1) 9-17
• 4 Rose EA, Gelijns AC, Moskowitz AJ , et al; Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001; 345 (20) 1435-1443
• 5 Slaughter MS, Rogers JG, Milano CA , et al; HeartMate II Investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009; 361 (23) 2241-2251
• 6 Goldstein DJ, Naftel D, Holman W , et al. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transplant 2012; 31 (11) 1151-1157
• 7 Gordon RJ, Weinberg AD, Pagani FD , et al; Ventricular Assist Device Infection Study Group. Prospective, multicenter study of ventricular assist device infections. Circulation 2013; 127 (6) 691-702
• 8 Nienaber JJ, Kusne S, Riaz T , et al; Mayo Cardiovascular Infections Study Group. Clinical manifestations and management of left ventricular assist device-associated infections. Clin Infect Dis 2013; 57 (10) 1438-1448
• 9 Sharma V, Deo SV, Stulak JM , et al. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg 2012; 94 (5) 1381-1386
• 10 Topkara VK, Kondareddy S, Malik F , et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg 2010; 90 (4) 1270-1277
• 11 Maniar S, Kondareddy S, Topkara VK. Left ventricular assist device-related infections: past, present and future. Expert Rev Med Devices 2011; 8 (5) 627-634
• 12 Oz MC, Gelijns AC, Miller L , et al. Left ventricular assist devices as permanent heart failure therapy: the price of progress. Ann Surg 2003; 238 (4) 577-583 , discussion 583–585
• 13 Pereda D, Conte JV. Left ventricular assist device driveline infections. Cardiol Clin 2011; 29 (4) 515-527
• 14 Holman WL, Park SJ, Long JW , et al; REMATCH Investigators. Infection in permanent circulatory support: experience from the REMATCH trial. J Heart Lung Transplant 2004; 23 (12) 1359-1365
• 15 Stulak JM, Maltais S, Cowger J , et al. Prevention of percutaneous driveline infection after left ventricular assist device implantation: prophylactic antibiotics are not necessary. ASAIO J 2013; 59 (6) 570-574