Left ventricular assist device driveline infections in three contemporary devices

Schlöglhofer, Thomas; Michalovics, Peter; Riebandt, Julia; Angleitner, Philipp; Stoiber, Martin; Laufer, Guenther; Schima, Heinrich; Wiedemann, Dominik; Zimpfer, Daniel; Moscato, Francesco

doi:10.1111/aor.13843

Cited by 28 publications

(66 citation statements)

References 23 publications

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“…32 Owing to biofilm on device material that cannot be easily removed/replaced, these infections often recur, requiring a variety of diagnostic and treatment measures, frequently combining conservative and surgical approach. 33,34 The most common organisms involved in DLIs are Grampositive skin flora such as Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]), coagulase-negative Staphylococci, causing > 50% of DLIs, 14,33,35 pyogenic Streptococci (e.g., Streptococcus pyogenes, Streptococcus agalactiae, etc. ), Coryneform bacteria, Enterococcus faecalis, Escherichia coli, Klebsiella sp., Proteus mirabilis, as well as Pseudomonas aeruginosa which is found in approximately 10 to 50% cases of DLI.…”

Section: Pathophysiology Of Vad-specific Infectionmentioning

confidence: 99%

“…34 It is important to highlight trauma as a leading cause of DLI 13,28,29 necessitating suture anchoring DLES during the first 2 weeks, and after its removal adhesive anchoring devices for driveline immobilization. 14,29,33,56,66 Many centers of expertise in VAD implantation and management follow general cardiac surgery guidelines in perioperative prophylaxis using firstand second-generation cephalosporins (cefazoline or cefuroxime) for 24 to 48 hours covering Gram-positive and Gram-negative bacteria, 4,67 whereas antifungal prophylaxis is not a routine. 68 In patients allergic to β-lactams and/or cephalosporins, clindamycin or vancomycin is an acceptable alternative covering Grampositive pathogens.…”

Section: Prevention Measuresmentioning

confidence: 99%

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Ventricular Assist Device Driveline Infections: A Systematic Review

Krželj

Petričević

Gašparović

et al. 2021

Thorac Cardiovasc Surg

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Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients.

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Section: Pathophysiology Of Vad-specific Infectionmentioning

confidence: 99%

Section: Prevention Measuresmentioning

confidence: 99%

Ventricular Assist Device Driveline Infections: A Systematic Review

Krželj

Petričević

Gašparović

et al. 2021

Thorac Cardiovasc Surg

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“…Readmission for a driveline infection was evaluated according to the device type in one study. Those authors reported that patients with an HM 3 had a higher risk for driveline infection readmissions compared to those with an HW HVAD or an HM II [ 11 ].…”

Section: Resultsmentioning

confidence: 99%

“…The frequency of driveline infections in patients using octenidine was 11.8%; no infections were found in patients using a merbromin solution. In the study by Schlöglhofer et al [ 11 ], octenidine was used as a cleaning agent and the driveline infection frequency was reported to be 27.3%. Hozayen et al [ 18 ] reported a driveline infection frequency of 13% when soap and antimicrobial spray were used to clean the driveline exit site.…”

Section: Resultsmentioning

confidence: 99%

Driveline exit-site care protocols in patients with left ventricular assist devices: a systematic review

Köken

Yalcin

Netten

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Driveline infections continue to be a significant complication following left ventricular assist device (LVAD) implantation. Driveline exit-site care is crucial for the prevention of infections; however, there are no uniform guidelines. The goal of this study was to provide an overview of the currently published driveline exit-site care protocols in patients with LVAD. METHODS A systematic literature review was performed. Studies before 15 December 2020 were included if the number of driveline infections was a primary outcome and the driveline exit-site care protocol was explained. RESULTS Eleven articles were included in the systematic review, including 1602 patients with LVADs. The median of the frequency of driveline infections in the articles was 13.8% with a range of 0–52.6%. There was a marked variability in the methods of care of driveline exit sites, without a standardized driveline dressing technique in patients with LVADs. The frequency of driveline infections was 6–7.5% in studies using a dressing kit that included chlorhexidine, a silver-based dressing and an anchoring device. Furthermore, there was variability in the anchoring devices and the frequency of dressing changes, which varied from daily to weekly. No specific anchoring device or change frequency was found to be superior. CONCLUSIONS Based on this systematic review, driveline exit care protocols that included chlorhexidine, a silver-based dressing, the use of an anchoring device and dressing kits might be best in reducing driveline infection rates. However, prospective studies with larger cohorts are needed to establish the optimal protocol for driveline exit-site care.

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“…However, for LVAD pumps satisfying the engineering criteria does not completely serve the purpose. In fact, the LVAD pumps must be hemocompatible enough to minimize the post‐implant complications like bleeding, stroke, and infections 9‐14 . Furthermore, the technological aspects like compactness, bearing design, and biocompatibility are also very crucial for a successful LVAD pump.…”

Section: Introductionmentioning

confidence: 99%

Comparative assessment of different versions of axial and centrifugal LVADs: A review

Kannojiya

Das

2021

Artificial Organs

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Continuous‐flow left ventricular assist devices (LVADs) have gained tremendous acceptance for the treatment of end‐stage heart failure patients. Among different versions, axial flow and centrifugal flow LVADs have shown remarkable potential for clinical implants. It is also very crucial to know which device serves its purpose better to treat heart failure patients. A thorough comparison of axial and centrifugal LVADs, which may guide doctors in deciding before the implant, still lacks in the literature. In this work, an assessment of axial and centrifugal LVADs has been made to suggest a better device by comparing their engineering, clinical, and technological development of design aspects. Hydrodynamic and hemodynamic aspects for both types of pumps are discussed along with their biocompatibility, bearing types, and sizes. It has been observed numerically that centrifugal LVADs perform better over axial LVADs in every engineering aspect like higher hydraulic efficiency, better characteristics curve, lesser power intake, and also lesser blood damage. However, the clinical outcomes suggest that centrifugal LVADs experience higher events of infections, renal, and respiratory dysfunction. In contrast, axial LVADs encountered higher bleeding and cardiac arrhythmia. Moreover, recent technological developments suggested that magnetic type bearings along with biocompatible coating improve the life of LVADs.

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Left ventricular assist device driveline infections in three contemporary devices

Cited by 28 publications

References 23 publications

Ventricular Assist Device Driveline Infections: A Systematic Review

Ventricular Assist Device Driveline Infections: A Systematic Review

Driveline exit-site care protocols in patients with left ventricular assist devices: a systematic review

Comparative assessment of different versions of axial and centrifugal LVADs: A review

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