title: Surgical management of driveline infections in patients with left ventricular assist devices.
abstract: OBJECTIVE
  Driveline infections in patients with implantable left ventricular assist devices (VAD) carry increasing risk for pump infection, thromboembolic events, decreased quality of life, and increased hospitalization. We report our experience with a surgical technique for refractory driveline infections without mediastinitis consisting of translocation and wrapping of the driveline with greater omentum tissue.
  
  
  METHODS
  We retrospectively reviewed data of VAD patients who underwent surgical treatment by translocation and wrapping with omentum for severe chronic driveline infection.
  
  
  RESULTS
  Thirteen patients were treated between January 2010 and October 2015; 12 (92%) were male, and the mean age was 56 ± 14 years. Ten patients (77%) were managed with driveline sheathing with omentum and repositioning with a new exit site, and three (23%), suffering from driveline fistula, with driveline covering with omentum maintaining the previous exit site. Three episodes of postoperative bleeding (23%) required surgical revision. Twelve patients (92%) were discharged from the hospital and one (8%) died. Nine patients (69%) were free from infection at the time of discharge, and three (23%) had recurrence of infection within the first postoperative year. Only four patients (31%) required admission to the intensive care unit; overall median hospital stay was 23 days (range 7-205 days).
  
  
  CONCLUSIONS
  Driveline relocation with use of omentum is a feasible and effective procedure in selected cases of chronic severe driveline infection. The risk for perioperative bleeding should be taken into consideration and carefully monitored.
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Anna Mara
authors.initials: AM
authors.lastname: Scandroglio
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Pergantis
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kretzschmar
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Kaufmann
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.|Department of Cardiothoracic Surgery, Charitè Medicine University, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Arlt
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
authors.forename: Evgenij
authors.initials: E
authors.lastname: Potapov
authors.affiliation: Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum; D011475:Prosthesis Failure / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome