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Driveline angle is crucial for preventing driveline infection in patients with HeartMate II device

  • Yorihiko Matsumoto
  • Satsuki Fukushima
  • Yusuke Shimahara
  • Kizuku Yamashita
  • Naonori Kawamoto
  • Kensuke Kuroda
  • Osamu Seguchi
  • Masanobu Yanase
  • Norihide Fukushima
  • Hideyuki Shimizu
  • Junjiro Kobayashi
  • Tomoyuki Fujita
Original Article Artificial Heart (Clinical)
  • 19 Downloads

Abstract

We hypothesized that the externalizing direction of the driveline (the driveline angle) at the percutaneous exit site would influence the occurrence of driveline infection after left ventricular assist device implantation. From August 2013 to May 2017, 71 patients were implanted with a HeartMate II device in our center. The driveline angle was measured on anteroposterior radiography just after implantation. Risk factors for driveline infection were analyzed by uni- and multivariate analyses. Driveline infection developed in 10 (14%) patients during follow-up. Overall actual freedoms from driveline infection at 6, 12, and 24 months were 96%, 88%, and 86%, respectively. Overall number of driveline infection events per patient-year was 0.16. Receiver operating characteristic analysis determined the cut-off point of the driveline angle as 41°. The 6-, 12-, and 24-month actuarial freedoms from driveline infection in those with driveline angle more than 42° (84%, 74%, and 74%, respectively) were significantly lower than in those with driveline angle less than 41° (97%, 94%, and 90%, respectively; p < 0.02). The numbers of driveline infection events per patient-year were 0.16 in patients with driveline angle more than 42°, and 0.04 in patients with driveline angle less than 41°. Multivariate analysis demonstrated that driveline angle more than 42° was an independent risk factor for driveline infection (hazard ratio 4.71). Driveline angle more than 42° is an independent risk factor for driveline infection in patients with HeartMate II. Externalization of the driveline toward the horizontal direction is important to prevent driveline infection with HeartMate II.

Keywords

Implantable LVAD Driveline infection Prevention HeartMate II Implant procedure 

Notes

Acknowledgements

The authors would like to thank Yuzo Takahashi, Hideki Yotsuida, Hiroshi Nishioka, Megumi Komiyama, Maiko Hattori, Yuto Kimura, Mao Nakahashi, Takaaki Nagai, Ayaka Arizono, Tomoko Tokunaga, Toshikazu Arai, Eri Miyoshi, Ai Nagayo, Nobuaki Konishi, Yumiko Hori, and Takako Nakaya for their roles in providing patient care. We thank Kelly Zammit, BVSc, from Edanz Group (http://www.edanzediting.com/ac), for editing a draft of this manuscript.

Funding

None declared.

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.

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Copyright information

© The Japanese Society for Artificial Organs 2018

Authors and Affiliations

  • Yorihiko Matsumoto
    • 1
    • 2
  • Satsuki Fukushima
    • 1
  • Yusuke Shimahara
    • 1
  • Kizuku Yamashita
    • 1
  • Naonori Kawamoto
    • 1
  • Kensuke Kuroda
    • 3
  • Osamu Seguchi
    • 3
  • Masanobu Yanase
    • 3
  • Norihide Fukushima
    • 3
  • Hideyuki Shimizu
    • 2
  • Junjiro Kobayashi
    • 1
    • 2
  • Tomoyuki Fujita
    • 1
  1. 1.Department of Cardiovascular SurgeryNational Cerebral and Cardiovascular CenterSuitaJapan
  2. 2.Department of Cardiovascular SurgeryKeio University School of MedicineTokyoJapan
  3. 3.Department of TransplantationNational Cerebral and Cardiovascular CenterSuitaJapan

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