How Does Double Tunnel Driveline Derivation Technique Contributes to Treatment of Driveline Infection?

Abstract

Driveline infection (DLI) is one of the major complications after durable VAD implantation. Since 2016, we have changed from the standard method to a double-tunnel method for driveline (DL) derivation, in which DL was once led to the upper right abdomen, then passed through the subcutaneous tissue horizontally to the left upper abdomen. This study aimed to verify the therapeutic efficacy of the double tunnel method on DLI. From April 2013 to January 2019, all 120 cases of HeartMate2(HM2) implanted for BTT at our hospital were divided into 2 groups; 38 cases for whom DL exited directly from the upper right abdomen (S group) or 82 cases of the double tunnel method (D group). There was no significant intergroup difference in age (41 vs 46; P = 0.05), male ratio 79% vs 67%, (p = 0.2), or BTB case (16% vs 31%, P = 0.1). DLI occurred in 12 cases (32%) in the S group and 14 cases (17%) in the D group (P = 0.1). The interval between the HM2 implantation and the first DLI occurrence was not significantly different (585 vs 414 days, P = 0.2). Treatment of the DLI was more conservative in the S group, where surgical DL translocation (DTL) was performed in 1 case (8%) in the S group and 10 cases (71%) in the D group (P <0.01). The DTL resulted in primary cure 1 case of the S group (100%) and 8 cases of the D group (80%). The 2 cases who failed to show primary cure post-DTL underwent pump exchange. The medical therapy and/or local irrigation was selected as the primary treatment of DLI in 8 cases of the S group (67%) and in 4 cases of the D group (29%) As a result, 1 case of the S group and 1 case of the D group showed the primary cure, whereas the remaining 10 cases (83%) continued daily wound care and intravenous antibiotics in hospital. DLI occurred one year or more after durable VAD implantation on average, regardless of the driveline derivation method. The double tunnel method contributed to opening the window for aggressive surgical treatment which more frequently resulted in a primary cure of the DLI than the conservative therapy.