title: Driveline infections in left ventricular assist devices: implications for destination therapy.
abstract: BACKGROUND
  Infection is one of the major limitations to successful long-term support after ventricular assist device implantation. There are limited data specifically examining the incidence and predictors of driveline infections (DLI), with a changing treatment paradigm toward destination therapy (DT) and longer duration of support.
  
  
  METHODS
  Between January 2007 and 2011, 143 patients underwent HeartMate II (Thoratec, Pleasanton, CA) implantation, with 87 (61%) as DT. Driveline maintenance strategy included sterile dressing changes with chlorhexidine and saline application, without prophylactic oral antibiotics.
  
  
  RESULTS
  DLI developed in 18 patients (12%) at a median of 182 days (range, 26 to 1,138 days) after implantation, among which 12 (66%) were from the DT cohort. Infections were superficial in 15 (82%) and deep in 3 (18%). Trauma was documented in 6 patients (33%). Seven patients (38%) needed readmission for DLI. Surgical debridement was needed in 3 (17%). All patients were managed successfully, without the need for device explantation or urgent cardiac transplantation. No patient required continuous antibiotic prophylaxis after the infection subsided. Risk factor analysis identified duration of support as the only independent predictor of infection (mean. 600 vs 390 days; p = 0.03). The odds of having a DLI rose by 4% for every month of support.
  
  
  CONCLUSIONS
  Longer duration of support significantly increased the risk of DLI and hence increased the risk of DLI in patients with DT. DLI may be successfully managed with antibiotics and local wound care. Most of the infections were superficial, and progression to deep pocket or pump infection is rare in our experience.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA. sharma.vikas@mayo.edu
authors: Vikas
authors: V
authors: Sharma
authors: Salil V
authors: SV
authors: Deo
authors: John M
authors: JM
authors: Stulak
authors: Lucian A
authors: LA
authors: Durham
authors: Richard C
authors: RC
authors: Daly
authors: Soon J
authors: SJ
authors: Park
authors: Larry M
authors: LM
authors: Baddour
authors: Kashish
authors: K
authors: Mehra
authors: Lyle D
authors: LD
authors: Joyce
mesh_terms: D005260:Female; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies