Risk of left ventricular assist device driveline infection: A systematic literature review

Pavlovic, Noelle; Randell, Tania; Madeira, Tim; Hsu, Steven; Zinoviev, Radoslav; Abshire, Martha

doi:10.1016/j.hrtlng.2018.11.002

Cited by 52 publications

(50 citation statements)

References 57 publications

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“…Young age and male sex were independent patient-related risk factors associated with higher DRI risk. These findings have been described by others in the field of cardiology 23 , 24 as well as in prosthetic joint infections 25 . There are no obvious reason for this diversity amongst gender; however, bacterial skin colonization differs among genders 26 which may reflect differences in host response to bacterial exposure.…”

Section: Discussionsupporting

confidence: 63%

Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982–2018)

Olsen

Jørgensen

Nielsen

et al. 2019

European Heart Journal

176

133

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Aims Device-related infection (DRI) is a severe complication to cardiac implantable electronic devices (CIED) therapy. Device-related infection incidence and its risk factors differ between previous studies. We aimed to define the long-term incidence and incidence rates of DRI for different types of CIEDs in the complete Danish device-cohort and identify patient-, operation- and device-related risk factors for DRI. Methods and results From the Danish Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Register, we included consecutive Danish patients undergoing CIED implantation or reoperation from January 1982 to April 2018, resulting in 97 750 patients, 128 045 operations and follow-up of in total 566 275 device years (DY). We identified 1827 DRI causing device removals. Device-related infection incidence during device lifetime was 1.19% (1.12–1.26) for PM, 1.91% (1.71–2.13) for ICD, 2.18% (1.78–2.64) for cardiac resynchronization therapy (CRT)-pacemakers (CRT-P), and 3.35% (2.92–3.83) for CRT-defibrillators (CRT-D). Incidence rates in de novo implantations were 2.04/1000 DY for PM, 3.84 for ICD, 4.38 for CRT-P, and 6.76 for CRT-D. Using multiple-record and multiple-event per subject proportional hazard analysis, we identified implantation of complex devices (ICD and CRT), reoperations, prior DRI, male sex, and younger age as significantly associated with higher DRI risk. Conclusion Overall risk of infection was low in PM implantations but considerably higher in CRT systems and after reinterventions. These data support the importance of evaluating all patients considered for CIED therapy thoroughly, in order to identify potential modifiable risk factors and reduce the risk of early reoperations.

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Section: Discussionsupporting

confidence: 63%

Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982–2018)

Olsen

Jørgensen

Nielsen

et al. 2019

European Heart Journal

176

133

View full text Add to dashboard Cite

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“…Driveline infection is a serious complication after implantation of a LVAD and significantly contributes to mortality. 1 In patients, who are intended for heart transplantation, driveline infection is a reason for urgent transplantation, although initial results are inferior. 2 Further surgical alternatives comprise explant of the infected device, relocation implant, 3 or omentum plasty.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Driveline Infection with Vacuum-Assisted Closure Therapy and Instillation Therapy

Kilo¹,

Dumfarth²,

Höfer³

et al. 2020

Thorac Cardiovasc Surg Rep

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Background Driveline infection is a serious complication in left ventricular assist device (LVAD) patients. We report the case of a patient who was successfully treated by combining instillation and vacuum-assisted closure (VAC) therapy. Case Description A 65-year-old LVAD patient presented with recurrent driveline infection. Local therapy with VAC therapy in combination with instillation of polyhexanide was performed for 2 weeks. The patient remains free from infection for twelve months by now. Conclusion This case is the first to present the combination of polyhexanide instillation with VAC as treatment for driveline infection. This therapy may thus be an option for patients who lack any other surgical option.

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“…6 Third, our 1-year actuarial VAD driveline infection rate was 43%, while 1-year rates at other centers range from 16% to 29%. 7 The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) reports a 1-year incidence rate of 19%. 7 Driveline infections can be lifethreatening, and thus, ongoing assessment of the driveline site is essential.…”

Section: Introductionmentioning

confidence: 99%

“…7 The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) reports a 1-year incidence rate of 19%. 7 Driveline infections can be lifethreatening, and thus, ongoing assessment of the driveline site is essential. Finally, malnutrition can significantly slow VAD patients' recovery and increase the risk for poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Health Care Performance Improvement Initiative to Facilitate Optimal Clinical Outcomes in Patients Receiving Ventricular Assist Device Support

et al. 2020

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Background: Ventricular assist device (VAD) patients are at high risk for morbidities and mortality. One potentially beneficial component of the Joint Commission VAD Certification process is the requirement that individual VAD programs select 4 performance measures to improve and optimize patients’ clinical outcomes. Problem Statement: Review of patient data after our program’s first certification visit in 2008 showed that, compared to national recommendations and published reports, our patients had suboptimal outcomes in 4 areas after device implantation: length of hospital stay, receipt of early (<48 hours) postsurgical physical therapy, driveline infection incidence, and adequacy of nutritional status (prealbumin ≥18 mg/dL). Methods: Plan-Do-Study-Act processes were implemented to shorten length of stay, increase patient receipt of early physical therapy, decrease driveline infection incidence, and improve nutritional status. With 2008 as our baseline, we deployed interventions for each outcome area across 2009 to 2017. Performance improvement activities included staff, patient, and family didactic, one-on-one, and hands-on education; procedural changes; and outcomes monitoring with feedback to staff on progress. Descriptive and inferential statistics were examined to document change in the outcomes. Outcomes: Across the performance improvement period, length of stay decreased from 40 to 23 days; physical therapy consults increased from 87% to 100% of patients; 1-year driveline infection incidence went from 38% to 23.5%; and the percentage of patients with prealbumin within the normal range increased from 84% to 90%. Implications: Performance improvement interventions may enhance ventricular assist device patient outcomes. Interventions’ sustainability should be evaluated to ensure that gains are not lost over time.

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Risk of left ventricular assist device driveline infection: A systematic literature review

Cited by 52 publications

References 57 publications

Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982–2018)

Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982–2018)

Successful Treatment of Driveline Infection with Vacuum-Assisted Closure Therapy and Instillation Therapy

Evaluation of a Health Care Performance Improvement Initiative to Facilitate Optimal Clinical Outcomes in Patients Receiving Ventricular Assist Device Support

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