117 Technique of HeartMate II Percutaneous Lead Externalization Is Associated with Incidence of Infection

Abstract

surgical operations without significantly increased risk of late mediastinitis or sternal wound infection. There are no data examining the late effects of this therapy after implantation of ventricular assist devices (VAD). Methods and Materials: Between October 1996 and October 2010, 364 patients underwent VAD implant. DSC was utilized in 184 (51%) pt for coagulopathy (155; 84%), hemodynamic instability (103; 56%), isolated RV dysfunction (15; 8%), or unspecified (17; 9%). Median duration of DSC was 1 day (range 1-7). Patients with DSC were older (54.5 vs. 50.3 yrs, p 0.002), had more prior sternotomies (42% vs. 28%, p 0.005), peop IABP (50% vs. 30%, p 0.001), preop mechanical circulatory support (23% vs. 10%, p 0.001), lower preop platelet count (171k vs. 209k, p 0.001) and lower hematocrit (32% vs. 36%, p 0.001). Results: DSC was not associated with a significant increase in operative (11% vs. 9%, p 0.65) or late (2 yr; 66 7% vs 66 7%; p 0.720) mortality, composite incidence of mediastinits, major driveline infection, pocket infection, device endocarditis (16% vs. 15%, p 0.79), re-exploration for bleeding (18% vs. 18%; p 0.99), urgent transplantation for infection (4% vs. 3%; p 0.99), or need for device exchange (9% vs. 10%; p 0.16). Patients with DSC had significantly longer ICU stay (10 vs. 5 days; p 0.001). Independent predictors of DSC included prior sternotomy (1.815 [1.097, 3.004]), preop IABP (2.009 [1.232, 3.275]), hematocrit (1.087 [1.031, 1.128]), platelet count (1.005 [1.002, 1.008]), concomitant tricuspid valve repair (6.153 [2.950, 12.831]), and RVAD (4.911 [2.242, 10.756]). Conclusions: DSC was performed after VAD implant most often for coagulopathy and hemodynamic instability. Patients with DSC are older with greater severity of illness manifest by greater degree of RV failure and greater history of prior sternotomy. DSC was associated with longer ICU stay, but not with a significantly increased risk of death or infection.