title: Special Treatment and Wound Care of the Driveline Exit Site after Left Ventricular Assist Device Implantation.
abstract: OBJECTIVE
  Despite good results following implantation of left ventricular assist devices (LVADs), infections of the driveline and device pocket remain a major problem for patients on long-term support. We present the data from heart failure patients treated with a Thoratec HeartMate-II LVAD (Thoratec Corporation, Pleasanton, California, United States).
  
  
  METHODS
  From January 2008 to April 2011, in our institution, 40 heart failure patients (NYHA IV) were supported with a HeartMate-II LVAD. The driveline maintenance of 17 patients consisted of the use of Octenidine for the wound dressing, whereas merbromin was additionally used for local irrigation in 31 patients. The data concerning driveline infections were analyzed retrospectively.
  
  
  RESULTS
  In our study, 95% of the entire cohort was free from infections of the system. Two patients in the conventional group (11.8%) developed a driveline infection at a mean of 130.5 days during 3,416 patient-days (0.21 infection/patient-years). In the Merbromid group (Co. New FaDem SRL Farmaceutici & Chimici, Giugliano, Campania, Italy), all patients were free from any driveline infections during the observation period. In a log-rank comparison, the difference reached statistical significance (p = 0.043).
  
  
  CONCLUSIONS
  During our observation period, fewer infections were noted with merbromin treatment. A multicenter setting in a larger cohort should be performed to confirm these findings, although a (double-) blinded setting might be difficult to achieve.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ares K
authors.initials: AK
authors.lastname: Menon
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Sophie-K
authors.initials: SK
authors.lastname: Baranski
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Unterkofler
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Moza
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Goetzenich
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Lachmandath
authors.initials: L
authors.lastname: Tewarie
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007097:Imines; D008297:Male; D008622:Merbromin / Q000627:therapeutic use*; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D011725:Pyridines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014945:Wound Healing
chemical_list: D000891:Anti-Infective Agents, Local; D007097:Imines; D011725:Pyridines; D008622:Merbromin; C034213:octenidine