Prevalence and management of driveline infections in mechanical circulatory support - a single center analysis

Abstract

Background Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. Methods Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. Results Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35–1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32–2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. Conclusions Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.

Successful Bacteriophage-Antibiotic Combination Therapy against Multidrug-Resistant Pseudomonas aeruginosa Left Ventricular Assist Device Driveline Infection

“…The standard treatment for driveline-associated infections involves systemic antibiotics; however, commonly, such an approach leads to treatment failure, and surgical relocation of LVAD driveline is necessary. In a study in Warsaw, Poland, the primary success rate with antibiotics was only 27%, driveline repositioning was needed for 73.1% of patients, and the mortality in these patients was 11.5% [ 4 ].…”

“…The main complications of LVAD are bleeding, thrombosis, pump failure, and infection, with the latter occurring in 50% of patients [ 3 ]. Like other implantable devices, infections associated with LVADs are complex to treat and often require device repositioning [ 4 ]. Pseudomonas aeruginosa is a frequently encountered pathogen that causes LVAD driveline-associated infections, which are challenging to manage due to the bacterium’s high rates of multidrug resistance and biofilm formation.…”

Bioprosthetic Total Artificial Heart Implantation Does Not Induce Chronic Inflammation

“…Indeed, these defects predispose LVAD recipients to systemic infections 19 . Driveline infections in LVAD remain one of the most common adverse events at the origin of complications 20,21 . Absence of immunity perturbation after A-TAH implantation could explain at least in part the absence of driveline infection in A-TAH.…”

Electrohydraulic Vascular Compression Device (e‐VaC) with Integrated Sensing and Controls

“…[10] Additionally, devices that avoid the use of drivelines greatly reduce the risk of driveline-related infections, which constitute a major clinical burden. [11] Notable recent trends in advanced mechanical cardiac support demonstrate increased interest in soft and highly conformable implantable devices and actuators to assist critical biological functions such as the contraction of cardiac tissue. [12][13][14][15] Specifically, soft robotics has emerged as a tool of high clinical relevance in the field of cardiac engineering, earning the moniker of "artificial muscles".…”