title: Double tunnel technique for the LVAD driveline: improved management regarding driveline infections.
abstract: A driveline exit site infection is a serious and common complication in long-term left ventricular assist device (LVAD) support. To reduce the incidence and severity of late driveline infections, we modified our surgical technique (double tunnel), and compared it to the conventional short and straight driveline tunnel technique (conventional). We analyzed 43 consecutive patients (37 HeartMate II; 6 Ventrassist) regarding late onset driveline exit site infections after using the surgical driveline tunnel technique after successful LVAD implantation. Of these 43 patients, 11 were treated with the conventional short and straight driveline tunnel technique (conventional), while 32 patients were treated with the modified long subfascial, C-shaped technique (double tunnel). We observed slightly fewer superficial driveline exit site infections in the double tunnel group, even though the difference was not statistically significant (0.638 vs. 1.148 infections/1,000 patient-days; P = 0.22). There were also insignificantly fewer surgical interventions because of exit site infections in the double tunnel group (0.159 vs. 0.581 revisions/1,000 patient-days; P = 0.18). The double tunnel technique offers more surgical options in the case of driveline exit site infections. Due to the long subfascial tunnel, the infected site can be separated from the new driveline exit site, and vacuum-assisted closure therapy can be applied to the infected area. In conclusion, we recommend using the double tunnel driveline technique because of the low infection rate and better treatment options in the case of driveline exit site infection.
authors: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. david.schibilsky@med.uni-tuebingen.de
authors: David
authors: D
authors: Schibilsky
authors: Christoph
authors: C
authors: Benk
authors: Christoph
authors: C
authors: Haller
authors: Michael
authors: M
authors: Berchtold-Herz
authors: Matthias
authors: M
authors: Siepe
authors: Friedhelm
authors: F
authors: Beyersdorf
authors: Christian
authors: C
authors: Schlensak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies