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Reduction of Driveline Infections Through Doubled Driveline Tunneling of Left Ventricular Assist Devices
Author(s) -
Fleissner Felix,
Avsar Murat,
Malehsa Doris,
Strueber Martin,
Haverich Axel,
Schmitto Jan D.
Publication year - 2013
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12036
Subject(s) - medicine , incidence (geometry) , surgery , cardiology , optics , physics
The durability of ventricular assist device ( VAD ) therapy improved steadily over the past years. However, driveline infections remain a challenge. To test whether an improved surgical implantation technique may lower the incidence of infections, we analyzed all patients receiving a VAD implantation in the years 2008 and 2009 (group 1) and compared them with all patients who received a VAD in 2011 (group 2) after we changed our implantation method. The new technique involves tunneling of the driveline into the fascia of the musculus rectus abdominis , resulting in a longer, intrafascial run to achieve a better resistance against ascending infections. We retrospectively analyzed 40 patients in group 1 and 41 patients in group 2. One year after implantation, the infection rate was markedly reduced (22.5% [ n = 9] group 1 vs. 4.9% [ n = 2] group 2, P < 0.001) by the new implantation method. There was, however, no significant improvement in overall mortality. The C ox regression model identified the implantation method as an independent risk factor for 1 year after implantation driveline infection ( P < 0.05). In conclusion, the new tunneling technique marks a great leap forward in long‐term VAD treatment. However, overall mortality remains high and needs further improvement.