Abstract
Different left ventricular assist devices (LVADs) are provided of different driveline exit sites: HeartWare HVAD presents abdominal power-cable-supply, while the Jarvik 2000 LVAD is powered by a retroauricular driveline. We analyzed 93 LVAD-implanted patients from January-2009 to October-2016 (41 HeartWare and 52 Jarvik 2000), hypothesizing a different incidence of infection, according to driveline exit site. The two populations were propensity matched for the demographic data and preoperative variables, and the outcomes were further analyzed. Nine driveline infections (DLIs) were in each LVAD group recorded (22% for HVAD and 17% for Jarvik 2000). The incidence of the complication was similar between groups (p = 0.97), even during time (p = 0.27 within 6 months and p = 0.16 over 6 months of support). Age at implant (p = 0.01), revision for bleeding (p = 0.05), days of postoperative intubation (p = 0.002), and ICU stay (p < 0.001), as well as days on device (p < 0.001) were identified as risk factors for DLIs. The type of device and the driveline exit site were not statistically co-related to infections. Similar infection-freedom survival was identified (p = 0.87). Younger age at implant, revision for bleeding, prolonged mechanical ventilation, delayed rehabilitation, as well as long time LVAD support were identified as risk factors for exit site DLIs. Despite similar incidence of DLIs, the different management and care of the retroauricular exit site makes it more appropriate and comfortable in long-term support.
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References
Kormos RL, Borovetz HS, Armitage JM, Hardesty RL, Marrone GC, Griffith BP. Evolving experience with mechanical circulatory support. Ann Surg. 1991;214:471–6 (discussion 476-7).
Petri WA Jr. Infections in heart transplant recipients. Clin Infect Dis. 1994;18:141–6 (Quiz 147-8).
Jarvik R, Westaby S, Katsumata T, Pigott D, Evans RD. LVAD power delivery. A percutaneous approach to avoid infection. Ann Thorac Surg. 1998;65:470–3.
Siegenthaler MP, Martin J, Pernice K, Doenst T, Sorg S, Trummer G, Friesewinkel O, Beyersdorf F. The Jarvik 2000 is associated with less infections than the HeartMate left ventricular assist device. Eur J Cardiothorac Surg. 2003;23:748–55.
Bottio T, Bejko J, Gallo M, Bortolussi G, Gerosa G. Less invasive implantation of HeartWare left ventricular assist device. Multimed Man Cardiothorac Surg. 2014. doi:10.1093/mmcts/mmu008.
Bejko J, Guariento A, Bortolussi G, Tarzia V, Gerosa G, Bottio T. Minimally invasive surgical Jarvik 2000 off-pump implantation. Multimed Man Cardiothorac Surg. 2015. doi:10.1093/mmcts/mmv020.
Bottio T, Bejko J, Guariento A, Tarzia V, Pittarello D, Gerosa G. Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia. J Cardiovasc Med (Hagerstown). 2016;17:160–4.
Bortolussi G, Lika A, Bejko J, Gallo M, Tarzia V, Gerosa G, Bottio T. Left ventricular assist device end-to-end connection to the left subclavian artery: an alternative technique. Ann Thorac Surg. 2015;100:e93–5.
Gallo M, Bortolussi G, Bejko J, Tarzia V, Gerosa G, Bottio T. How to remove the retroauricular driveline in the Jarvik 2000 after heart transplantation. Int J Artif Organs. 2016;39:45–7.
Bejko J, Tarzia V, Gerosa G, Bottio T. Use of the Jarvik 2000 to facilitate left ventricular assist device placement in challenging apex anatomy. J Heart Lung Transpl. 2016;35:1049–51.
Gerosa G, Gallo M, Tarzia V, Di Gregorio G, Zanella F, Bottio T. Less invasive surgical and perfusion technique for implantation of the Jarvik 2000 left ventricular assist device. Ann Thorac Surg. 2013;96:712–4.
Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, Schueler S, Holman WL, Lawler LP, Gordon SM, Mahon NG, Herre JM, Gould K, Montoya JG, Padera RF, Kormos RL, Conte JV, Mooney ML. International Society for Heart and Lung Transplantation. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transpl. 2011;30:375–84.
Sharma V, Deo SV, Stulak JM, Durham LA 3rd, Daly RC, Park SJ, Baddour LM, Mehra K, Joyce LD. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg. 2012;94:1381–6.
Pereda D, Conte JV. Left ventricular assist device driveline infections. Cardiol Clin. 2011;29:515–27.
Akhter SA, Badami A, Murray M, Kohmoto T, Lozonschi L, Osaki S, Lushaj EB. Hospital readmissions after continuous-flow left ventricular assist device implantation: incidence, causes, and cost analysis. Ann Thorac Surg. 2015;100:884–9.
Centofanti P, Attisani M, Bosco GF, Khayat A, La Torre M, Baronetto A, Boffini M, Rinaldi M. Successful replacement of a detached pedestal during support with Jarvik 2000. Int J Artif Organs. 2012;35:152–5.
Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Ewald GA, Shelton K, Pasque MK, Moon MR, Damiano RJ Jr, Moazami N. Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg. 2007;84:515–20.
Califano S, Pagani FD, Malani PN. Left ventricular assist device-associated infections. Infect Dis Clin N Am. 2012;26:77–87.
Meszaros K, Fuehrer U, Grogg S, Sodeck G, Czerny M, Marschall J, Carrel T. Risk factors for sternal wound infection after open heart operations vary according to type of operation. Ann Thorac Surg. 2016;101:1418–25.
Goldstein DJ, Naftel D, Holman W, Bellumkonda L, Pamboukian SV, Pagani FD, Kirklin J. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transpl. 2012;31:1151–7.
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Bejko, J., Toto, F., Gregori, D. et al. Left ventricle assist devices and driveline’s infection incidence: a single-centre experience. J Artif Organs 21, 52–60 (2018). https://doi.org/10.1007/s10047-017-0997-y
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DOI: https://doi.org/10.1007/s10047-017-0997-y