title: Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections.
abstract: BACKGROUND
  Drive-line infection (DLI) is a common complication of left ventricular assist device (LVAD) support, leading to significant morbidity that jeopardizes the benefits of these devices. It has been reported that DLI incidence is related to drive-line dressing strategies. The aim of this study was to determine whether implementation of a standardized drive-line care kit would reduce the incidence of DLIs.
  
  
  METHODS
  DLI data were collected prospectively on all LVAD patients implanted between 2009 and 2013 at Columbia University Medical Center. Drive-line care was altered on June 1, 2011, from a dry sterile dressing without a standard anchoring device to a standardized kit, which included silver gauze dressing and a standard anchoring device. The silver dressing was used until the wound incorporated, with a minimum of 1 month.
  
  
  RESULTS
  During the study period, 107 patients were implanted with LVADs before implementation of a standardized kit (Group A) and 159 thereafter (Group B). Median follow-up time (censoring at June 2011) for Group A was 8.73 (IQR 3.51 to 17.47) months and 11.65 (IQR 6.66 to 35.20) months for Group B (p = 0.17). DLI event rate improved from 0.18 to 0.07 event per patient-year, corresponding to a relative risk reduction of 62.5%. In addition, the 1-year freedom from infection was significantly increased in Group B (92.46%) compared with Group A (81.94%) (log rank = 0.036).
  
  
  CONCLUSIONS
  The use of a standardized kit, including silver dressing and a standard anchoring device, leads to decrease in DLI with an absolute risk reduction of 11%. Routine use of these dressing techniques is warranted based on our findings, and may lead to reduction of complications related to infections.
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cagliostro
authors.affiliation: Department of Cardiology, Columbia University, New York, New York.
authors.forename: Allison P
authors.initials: AP
authors.lastname: Levin
authors.affiliation: Department of Cardiology, Columbia University, New York, New York.
authors.forename: Justin
authors.initials: J
authors.lastname: Fried
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York.
authors.forename: Grant
authors.initials: G
authors.lastname: Parkis
authors.affiliation: Department of Cardiology, Columbia University, New York, New York.
authors.forename: Kanika P
authors.initials: KP
authors.lastname: Mody
authors.affiliation: Department of Cardiology, Columbia University, New York, New York.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Garan
authors.affiliation: Department of Cardiology, Columbia University, New York, New York.
authors.forename: Veli
authors.initials: V
authors.lastname: Topkara
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: Department of Cardiology, University of Chicago, Chicago, Illinois. Electronic address: nuriel@medicine.bsd.uchicago.edu.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: CFLVAD; driveline; infection; kit; reduction; silver dressing