Driveline Relocation and Vacuum-Assisted Closure for Ventricular Assist Device Driveline Infections

Background: Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs and discuss surgical treatment modalities. Methods We retrospectively reviewed 90 patients who underwent left or biventricular ventricular assist device (LVAD or BiVAD) implantation with HeartMate 2 (Abbott), HeartWare HVAD (Medtronic), HeartMate 3 (Abbott) in a single center between March 01, 2011, and May 30, 2023. Results DLIs were detected in 20 (%21.5) patients in the follow-up. The mean duration of VAD support was 561.1±833.2 days (1-4124 days), while 1277.9±621.6 days in the DLI group. Extended duration of VAD support was associated with higher incidence rates of late-onset DLIs (p< 0.05). Younger age and lower plasma albumin levels were independent predictive factors for the risk of DLI with a hazard ratio of 9.77 (95% CI: 1.3 – 74.5) and 10.55 (95% CI: 1.40 – 79.35), respectively. Removal of the biofilm with velour and DL relocation through the rectus muscle combined with vacuum-assisted strategies (VAC) was performed in 9 patients. One patient developed recurrent infection, and another patient with deep DLI subsequently received a heart transplant. No patient underwent device exchange for intractable DLIs. Conclusions Our results suggest that DLIs are common infectious complications after VAD implantation, which endanger patient autonomy, impair quality of life and overall survival. DL relocation through rectus muscles and VAC strategies have a role in controlling DLIs.