Tomasz Dziodzio1, Mariusz Kuśmierczyk2, Andrzej Juraszek3, Mikołaj Smólski4, Piotr Kołsut2, Jarosław Szymański2, Paweł Litwiński2, Krzysztof Kuśmierski2, Joanna Zakrzewska-Koperska5, Maciej Sterliński5. 1. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. tomasz.dziodzio@charite.de. 2. Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland. 3. Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland. anderso@o2.pl. 4. Medical University of Warsaw, Warsaw, Poland. 5. 1st Department of Arrhythmia, The Cardinal Stefan Wyszyński National Institute of Cardiology, Warsaw, Poland.
Abstract
BACKGROUND: Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. METHODS: Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. RESULTS: Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35-1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32-2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. CONCLUSIONS: Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infected patients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.
BACKGROUND: Driveline infections in continuous-flow left ventricular assist devices (cf-LVAD) remain the most common adverse event. This single-center retrospective study investigated the risk factors, prevalence and management of driveline infections. METHODS:Patients treated after cf-LVAD implantation from December 2014 to January 2020 were enrolled. Baseline data were collected and potential risk factors were elaborated. The multi-modal treatment was based on antibiotic therapy, daily wound care, surgical driveline reposition, and heart transplantation. Time of infection development, freedom of reinfection, freedom of heart transplantation, and death in the follow-up time were investigated. RESULTS: Of 75 observed patients, 26 (34.7%) developed a driveline infection. The mean time from implantation to infection diagnosis was 463 (±399; range, 35-1400) days. The most common pathogen was Staphylococcus aureus (n = 15, 60%). First-line therapy was based on antibiotics, with a primary success rate of 27%. The majority of patients (n = 19; 73.1%) were treated with surgical reposition after initial antibiotic therapy. During the follow-up time of 569 (±506; range 32-2093) days, the reinfection freedom after surgical transposition was 57.9%. Heart transplantation was performed in eight patients due to resistant infection. The overall mortality for driveline infection was 11.5%. CONCLUSIONS: Driveline infections are frequent in patients with implanted cf-LVAD, and treatment does not efficiently avoid reinfection, leading to moderate mortality rates. Only about a quarter of the infectedpatients were cured with antibiotics alone. Surgical driveline reposition is a reasonable treatment option and does not preclude subsequent heart transplantation due to limited reinfection freedom.
Authors: James K Kirklin; Francis D Pagani; Robert L Kormos; Lynne W Stevenson; Elizabeth D Blume; Susan L Myers; Marissa A Miller; J Timothy Baldwin; James B Young; David C Naftel Journal: J Heart Lung Transplant Date: 2017-07-15 Impact factor: 10.247
Authors: Chetan B Patel; Laura Blue; Barbara Cagliostro; Stephen H Bailey; John W Entwistle; Ranjit John; Vinay Thohan; Joseph C Cleveland; Daniel J Goldstein; Nir Uriel; Xiaolu Su; Sami I Somo; Poornima Sood; Mandeep R Mehra Journal: J Heart Lung Transplant Date: 2020-03-20 Impact factor: 10.247
Authors: Agnieszka Biełka; Mariusz Kalinowski; Michał Hawranek; Justyna Małyszek-Tumidajewicz; Jerzy Pacholewicz; Anetta Kowalczuk-Wieteska; Katarzyna Ratman; Grzegorz Kubiak; Bogumiła Król; Piotr Przybyłowski; Marian Zembala; Michał O Zembala Journal: Kardiol Pol Date: 2020-07-17 Impact factor: 3.108
Authors: Alexander M Bernhardt; Thomas Schlöglhofer; Volker Lauenroth; Florian Mueller; Marcus Mueller; Alexandra Schoede; Christian Klopsch Journal: J Crit Care Date: 2019-12-17 Impact factor: 3.425
Authors: Leonhard Wert; Jasmin S Hanke; Günes Dogan; Marcel Ricklefs; Felix Fleißner; Anamika Chatterjee; Christina Feldmann; Axel Haverich; Jan D Schmitto Journal: J Thorac Dis Date: 2018-06 Impact factor: 2.895
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: Florin Alexandru Pleșoianu; Carmen Elena Pleșoianu; Iris Bararu Bojan; Andrei Bojan; Andrei Țăruș; Grigore Tinică Journal: Bioengineering (Basel) Date: 2022-05-06