Reduction of Driveline Infections Through Doubled Driveline Tunneling of Left Ventricular Assist Devices

Abstract

The durability of ventricular assist device (VAD) therapy improved steadily over the past years. However, driveline infections remain a challenge. To test whether an improved surgical implantation technique may lower the incidence of infections, we analyzed all patients receiving a VAD implantation in the years 2008 and 2009 (group 1) and compared them with all patients who received a VAD in 2011 (group 2) after we changed our implantation method. The new technique involves tunneling of the driveline into the fascia of the musculus rectus abdominis, resulting in a longer, intrafascial run to achieve a better resistance against ascending infections. We retrospectively analyzed 40 patients in group 1 and 41 patients in group 2. One year after implantation, the infection rate was markedly reduced (22.5% [n = 9] group 1 vs. 4.9% [n = 2] group 2, P < 0.001) by the new implantation method. There was, however, no significant improvement in overall mortality. The Cox regression model identified the implantation method as an independent risk factor for 1 year after implantation driveline infection (P < 0.05). In conclusion, the new tunneling technique marks a great leap forward in long-term VAD treatment. However, overall mortality remains high and needs further improvement.

A Review of Infections in Patients with Left Ventricular Assist Devices: Prevention, Diagnosis and Management

“…19 Surgical techniques such as increasing intrafascial tunneling of the driveline may help reduce infections. 20,21 Additionally, externalization of the silicone portion of the driveline (as opposed to the velour portion) also decreases infections.…”

Minimally Invasive Ventricular Assist Device Surgery

“…The driveline is placed in the sheath of the rectus muscle in the umbilical direction and then subcutaneously to the right or left upper quadrant. This approach enlarges the subcutaneous driveline course, decreasing infection rates .…”

Rectus-Sparing Technique for Driveline Insertion of Ventricular Assist Device

“…A few case series have described modifications to VAD driveline placement that focus on longer subfascial tunnels [6,7] or externalization of less porous sections of the driveline [8]. The technique we present here is unique in that our focus is to preserve the integrity of the abdominal wall muscle layer.…”