Driveline Infection: Reroute or Not to Reroute, That is the Question

Abstract

<h3>Purpose</h3> Driveline infections (DLIs) are common adverse events for pts on continued left ventricular assist device (LVAD) support. We present a single center investigation of surgical treatment for DLI including culprit organisms, reintervention rates, and days free from reinfection. <h3>Methods</h3> A review of our institutional LVAD database included all pts implanted from June 2015 to June 2020. DLIs were identified as a clinical or radiographical diagnosis and included in this cohort. Surgical treatment included incision, drainage and debridement (I&D) with or without driveline rerouting (DR) (see Figure 1). Baseline characteristics, DL exit site at time of implantation, time to first infection, reintervention, and freedom from reinfection were examined. <h3>Results</h3> 148 pts received an LVAD during the study period. 31(21%) pts developed DLI, and 20(65%) underwent surgical therapy. Of those undergoing surgery, mean age 59 years, 17(85%) male, average BMI 28.4 kg/m², and 5(25%) were diabetic. 15(75%) pts were implanted as destination therapy. The implanted devices were Heartmate 3 (14), Heartmate II (5), and HeartWare HVAD (1). 6 pts had DL tunneled in right lateral abdomen and 14 in left. Pts with a left-sided DL, 10(71%) utilized a counterincision in the right abdomen. Time to first DLI following LVAD implant was on average 476 days (70-1089 days). Surgical intervention at first infection included 14 DR and 6 I&D. 9(45%) pts had recurrent DLI of which 2 required reintervention, a device exchange and a rerouting. Mean time for reinfection after rerouting was 230 days and 146 days following I&D. Freedom from repeat surgical intervention in 11 pts lasted on average 350 days (59-579 days). 4 pts underwent heart transplant. The most common bacteria were MSSA 6(30%), pseudomonas 5(20%), and MRSA 3(15%). <h3>Conclusion</h3> Driveline rerouting is a successful intervention to temporize and control a DLI. Compared to I&D, rerouting of the driveline may offer better freedom from reintervention. Further investigation into indications for rerouting is warranted.