Driveline Infection in Patients With Left Ventricular Assist Devices Implanted as Destination Therapy

• Published in: Transplantation proceedings 2024-05, Vol.56 (4), p.860-863
• Main Authors: Wasilewski, Grzegorz, Wiśniowska-Śmiałek, Sylwia, Górkiewicz-Kot, Izabela, Milaniak, Irena, Kaleta, Michał, Hymczak, Hubert, Wasilewska, Agata, Wierzbicki, Karol
• Format: Article
• Language: English
• Subjects: Female; Heart Failure - surgery; Heart Failure - therapy; Heart-Assist Devices - adverse effects; Humans; Male; Middle Aged; Prosthesis-Related Infections - etiology; Retrospective Studies
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2024.03.029

•Heart transplantation is the treatment of choice for selected patients with end-stage heart failure. Because of donor organ shortages, there has been a growing interest in alternative strategies, in particular mechanical circulatory support, not only as a bridge to transplantation but also as a destination therapy (DT).•In Poland, the implantation of left ventricular assist devices (LVADs) is still registered as a bridge to transplantation, a bridge to candidacy, but has yet to be registered as a DT. The outcomes, however, force the decisive institutions to proceed with the registration of LVAD implantation as a DT next year.•Although these mechanical circulatory support devices, especially third-generation full magnetic pumps, have significantly improved survival rates and quality of life, the evolution of LVADs is challenging. One such formidable complication that continues to pose a significant clinical dilemma is driveline infection. Although drivelines are crucial in maintaining device functionality, they also serve as potential entry points for pathogens, leading to infections that can seriously affect patients.•Patients receiving LVADs as DT are often immunocompromised due to advanced age, comorbidities like diabetes, or the use of specific medications. This compromised immune status increases susceptibility to infections involving driveline infections. The most important complication of driveline infection is the development of bloodstream infection.•Optimal surgical techniques and early implementation of targeted antibiotics are crucial. In our cohort, the most frequent pathogen revealed in wound swab culture was Staphylococcus aureus (MSS) methicillin-sensitive Staphylococcus (n = 23; 44%) and Pseudomonas aeruginosa (n = 9; 17%), which was in line with the research from other centers worldwide. Donor organ shortages cause increasing demand for mechanical circulatory support in patients with end-stage heart failure not only as a bridge to heart transplantation but mainly as a destination therapy. Improved results and increased applicability and durability of left ventricular assist devices (LVADs) have established this treatment option as an alternative to heart transplantation in selected patients. One of the most common complications after LVAD implantation is driveline infections (DLIs). This study aimed to expand the understanding of DLI epidemiology and potential changes in implantation techniques regarding optimizing DLI prevention and trea