Driveline Rerouting and Incision & Drainage for the Management of Chronic Driveline Infection in LVAD Recipients

Abstract

Driveline infections (DLI) contribute significant morbidity to patients implanted with a left ventricular assist device (LVAD). Refractory infection despite appropriate antibiotic therapy warrants surgical intervention. We report the long-term results of patients undergoing surgical treatment for DLI. A single institutional retrospective chart review was performed for patients undergoing surgical treatment for DLIs from January 2017 to June 2019. Cohorts were defined by the index surgical procedure for a DLI; incision and drainage (I&D) or driveline rerouting(DR). DR included wide debridement of the infected tract, stripping of the velour, and re-tunneling of the driveline utilizing a sterile pieced of plastic tubing that was tunneled to a new exit site. (Figure 1) RESULTS: Fifteen patients underwent surgical therapy for DLIs. Mean age was 60 years. 13 (87%) patients were male. Average BMI was 26 kg/m2 and 5(33%) patients had DM. Implantation strategy was bridge to transplant (4) and destination therapy (11). Implanted devices included Heartmate III (9 pts), Heartmate II (5 pts) and HeartWare (1 pt). Median cardiopulmonary bypass time on index implantation was 76 (62-144) minutes. The most common presentation of DLI was driveline exit site drainage in 13(86%) pts. Gallium scan was performed in 12(80%) patients, 11 (92%) which showed increased uptake at driveline site. Average time to first DLI from LVAD implant was 552 days. Index surgical treatment for DLI included DR (8) and I&D (7). Recurrent infection was common (7(47%)pts), 3 DLI and 4 I&D pts. Mean time for reinfection after rerouting was 261 days and after I&D was 135 days. The difference in means was not statistically significant (p=0.86). Driveline rerouting is an acceptable treatment strategy for DLI. Compared to local drainage procedures, DR may result in an increased time free from recurrent infection. Reinfection rates are high in all cases of DLI and most occur less than 1 year after intervention.