PMID- 17643627
OWN - NLM
STAT- MEDLINE
DCOM- 20070817
LR  - 20191210
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 84
IP  - 2
DP  - 2007 Aug
TI  - Late-onset driveline infections: the Achilles' heel of prolonged left ventricular 
      assist device support.
PG  - 515-20
AB  - BACKGROUND: A successful left ventricular assist device (LVAD) long-term support 
      in an outpatient setting demands that device-related complications are reduced to 
      a minimum. We hypothesized that late onset driveline infections have serious 
      implications on the anticipated application of LVAD as permanent therapy. 
      METHODS: Between 1996 and 2005, 73 patients were implanted with the Novacor 
      (World Heart Corp, Ottawa, Ontario, Canada; n = 35) or the HeartMate (Thoratec 
      Corp, Pleasanton, CA; n = 38) as either bridge to transplantation (n = 44) or 
      destination therapy (n = 29). Our analysis focused on patients with late-onset 
      infection (> or = 30 days) of the driveline exit site with prior clinical healing 
      of all incisions. RESULTS: Late driveline infections developed in 17 patients 
      (23%) at a median of 158 days (intraquartile range [IQR]: 68 to 213 days) after 
      implantation. The median duration of support in this subgroup was 400 days (IQR, 
      283 to 849 days). Despite an aggressive treatment algorithm, repeat surgical 
      revision was needed in 12 patients, up to six times in 2 individuals. In 6 
      patients, the infection progressed to pump pocket infections that led to urgent 
      heart transplantation (n = 4) or explantation (n = 2). The individual risk that a 
      driveline infection would develop dramatically increased with the duration of 
      support, reaching 94% at 1 year. Multivariate analysis identified duration of 
      support (p < 0.001) and documented trauma at the driveline exit site (p < 0.001) 
      as independent predictors of infection. Number and duration of readmissions to 
      the hospital significantly increased (p < 0.001), and long-term follow-up for 
      survival (4.4 +/- 2.2 years, 100% complete) showed a trend towards impaired 
      outcome after driveline infection (5-year survival: 41% versus 70%, p = 0.10). 
      CONCLUSIONS: Long-term LVAD support in the current series was jeopardized by 
      late-onset driveline infections, which occurred in all patients with support 
      duration longer than 1 year. Once driveline infections developed, they were 
      difficult to control and significantly increased morbidity.
FAU - Zierer, Andreas
AU  - Zierer A
AD  - Division of Cardiothoracic Surgery, Washington University School of Medicine, 
      Barnes-Jewish Hospital, St. Louis, Missouri 62236, USA.
FAU - Melby, Spencer J
AU  - Melby SJ
FAU - Voeller, Rochus K
AU  - Voeller RK
FAU - Guthrie, Tracey J
AU  - Guthrie TJ
FAU - Ewald, Gregory A
AU  - Ewald GA
FAU - Shelton, Kim
AU  - Shelton K
FAU - Pasque, Michael K
AU  - Pasque MK
FAU - Moon, Marc R
AU  - Moon MR
FAU - Damiano, Ralph J Jr
AU  - Damiano RJ Jr
FAU - Moazami, Nader
AU  - Moazami N
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2007 Aug;84(2):520-1. PMID: 17643628
MH  - Adult
MH  - Equipment Design
MH  - Female
MH  - *Heart Transplantation
MH  - Heart Ventricles
MH  - Heart-Assist Devices/*adverse effects
MH  - Humans
MH  - Infections/*epidemiology
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - *Ventricular Function, Left
MH  - Waiting Lists
EDAT- 2007/07/24 09:00
MHDA- 2007/08/19 09:00
CRDT- 2007/07/24 09:00
PHST- 2007/01/24 00:00 [received]
PHST- 2007/03/24 00:00 [revised]
PHST- 2007/03/27 00:00 [accepted]
PHST- 2007/07/24 09:00 [pubmed]
PHST- 2007/08/19 09:00 [medline]
PHST- 2007/07/24 09:00 [entrez]
AID - S0003-4975(07)00695-9 [pii]
AID - 10.1016/j.athoracsur.2007.03.085 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2007 Aug;84(2):515-20. doi: 10.1016/j.athoracsur.2007.03.085.