Fatal Flaw – Driveline Fracture as a Rare But Serious Complication Of Mechanical Circulatory Support With Left Ventricular Assist Devices

Abstract

Background
 Patients with advanced heart failure have seen decreased mortality and improved quality of life due to mechanical circulatory support with left ventricular assist devices (LVAD). Regardless of such outcomes, many complications still exist and remain a significant cause of morbidity and mortality. Our purpose is to study the prevalence, clinical course, and outcomes specifically of patients with LVAD driveline (DL) fractures.
 Methods
 This single-center, retrospective review included all patients at our institution who had continuous flow LVADs and experienced DL fracture/injury from January 2012 - December 2015.
 Results
 Thirteen of 110 LVAD patients (11.8%) had DL fractures (Table 1). Time from implant to time of fracture was 23+/-16.5 months. The majority of fractures were external (62%), due to trauma (i.e. cut during dressing change). Internal injury, proximal to the cutaneous exit site, occurred in 38% of patients, usually due to unknown causes. Only one patient (7.6%) survived on LVAD support. One survived LVAD explant, two underwent pump exchange, and four others underwent heart transplantation. The remaining 5 expired. All patients with untreated internal fractures died (60%).
 Conclusions
 Driveline fracture is a rare complication of LVAD and is often lethal when it occurs. Only one patient in our cohort survived without the need for heart transplant, LVAD exchange, or explant. Internal driveline fractures portend a very high mortality. Driveline fracture, especially one that cannot be promptly repaired or if internal fracture is suspected, requires immediate pump exchange or listing for heart transplant.