BACKGROUND: The most prevalent and serious infection related to left ventricular assist devices (LVADs) is driveline infection (DLI). From 2014, we employed a revised surgical technique (triple tunnel method), which deployed a longer subfascial driveline (DL) route. METHODS AND PATIENTS: We retrospectively analyzed 34 patients fitted with either of the two types of axial pumps: HeartMate II (n=23) and Jarvik 2000 (n=11). Prior to 2014, the DL proceeded from the pump pocket just above the posterior sheath of the rectus muscle toward a vertical skin incision at the right lateral border of the rectus muscle. Then, DL was turned leftward into the subcutaneous tissue to redirect its exit to the left side [subcutaneous tissue group (Group S): n=14]. From 2014, we made an additional skin incision below the umbilicus with the aim of lengthening the subfascial DL route [muscle group (Group M): n=20]. RESULTS: DLI occurred in 10 patients (71.4%) in Group S and in 1 patient (5%) in Group M (p<0.05, Chi-square test). The freedom rate from re-admission at 1 year due to DLI was 64% in Group S and 95% in Group M, respectively (p=0.021, log-rank test). Furthermore, logistic regression analysis revealed that DL route was significantly associated with DLI (odds ratio, 10.1; 95% confidence interval, 1.15-275.3). CONCLUSION: Although a longer follow-up period will be needed, the triple tunnel method may be beneficial in the prevention of DLI.
BACKGROUND: The most prevalent and serious infection related to left ventricular assist devices (LVADs) is driveline infection (DLI). From 2014, we employed a revised surgical technique (triple tunnel method), which deployed a longer subfascial driveline (DL) route. METHODS AND PATIENTS: We retrospectively analyzed 34 patients fitted with either of the two types of axial pumps: HeartMate II (n=23) and Jarvik 2000 (n=11). Prior to 2014, the DL proceeded from the pump pocket just above the posterior sheath of the rectus muscle toward a vertical skin incision at the right lateral border of the rectus muscle. Then, DL was turned leftward into the subcutaneous tissue to redirect its exit to the left side [subcutaneous tissue group (Group S): n=14]. From 2014, we made an additional skin incision below the umbilicus with the aim of lengthening the subfascial DL route [muscle group (Group M): n=20]. RESULTS: DLI occurred in 10 patients (71.4%) in Group S and in 1 patient (5%) in Group M (p<0.05, Chi-square test). The freedom rate from re-admission at 1 year due to DLI was 64% in Group S and 95% in Group M, respectively (p=0.021, log-rank test). Furthermore, logistic regression analysis revealed that DL route was significantly associated with DLI (odds ratio, 10.1; 95% confidence interval, 1.15-275.3). CONCLUSION: Although a longer follow-up period will be needed, the triple tunnel method may be beneficial in the prevention of DLI.
Authors: Julia Seretny; Tara Pidborochynski; Holger Buchholz; Darren H Freed; Roderick MacArthur; Nicole Dubyk; Laura Cunliffe; Osiris Zelaya; Jennifer Conway Journal: BMJ Open Qual Date: 2022-05
Authors: Radoslav Zinoviev; Christopher K Lippincott; Sara C Keller; Nisha A Gilotra Journal: Open Forum Infect Dis Date: 2020-04-17 Impact factor: 3.835
Authors: Melanie Kranzl; Martin Stoiber; Anne-Kristin Schaefer; Julia Riebandt; Dominik Wiedemann; Christiane Marko; Günther Laufer; Daniel Zimpfer; Heinrich Schima; Thomas Schlöglhofer Journal: Front Cardiovasc Med Date: 2021-12-16