title: Reduction of driveline infections through doubled driveline tunneling of left ventricular assist devices.
abstract: 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 Cox 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.
authors.affiliation: Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Fleissner
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.forename: Doris
authors.initials: D
authors.lastname: Malehsa
authors.forename: Martin
authors.initials: M
authors.lastname: Strueber
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Jan D
authors.initials: JD
authors.lastname: Schmitto
mesh_terms: D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000382:microbiology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D016896:Treatment Outcome