Abstract
Driveline infections (DLI), the main entity of VAD specific infections, in chronic mechanical circulatory support (MCS) increase with extended support times and contribute significantly to mortality and morbidity. The incidence of DLIs remains high at up to 30% at one year and often necessitate extensive surgical revisions, VAD exchange, or heart transplantation. Recently, an absorbable antimicrobial mesh impregnated with rifampin and minocycline (TYRX) was demonstrated to significantly reduce chronic implantable electric device infections. We evaluated the incidence of major DLIs in patients supported mechanically with or without the use of TYRX. Starting January 2015, 63 patients were supported by chronic MCS (HVAD: 60, HM3: 3) without TYRX use (group1); while starting December 2017, 56 patients were supported by chronic MCS (HVAD: 55, HM3: 1) with the additional use of TYRX to the driveline (group2). Operative technique and follow-up care remained unchanged. Major driveline infections were defined by the need of surgical revision, VAD exchange, heart transplantation, or life-time antibiotic treatment. Statistical significance was calculated by the log-rank test. In group 2, TYRX was tolerated in all 56 patients without any specific complication. Mean observation time was 891 days (37 to 1730) in group 1 and 285 days (40 to 679) in group 2. In group 1, 18 major DLI (28.6%) were documented at a mean of 459 days (23 to 1086) of support, and freedom of major DLI at one year was 84%. In group 2, 1 major DLI (1.8%) was detected at 291 days of support, and freedom of major DLI at one year was 96%. Comparison of the two groups reached statistical significance favoring TYRX use (p=0.045). In a single-center observation, additional wrapping of an absorbable antimicrobial mesh (TYRX) is safe, feasible, and significantly reduces the incidence of major driveline infection.
Published Version
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