Modified HeartMate II driveline externalization technique significantly decreases incidence of infection and improves long-term survival.

Abstract

Driveline (DL) infection has been a major source of morbidity and mortality following HeartMate II left ventricular assist device (LVAD) implant, despite a significantly lower incidence compared with pulsatile flow devices. The purpose of this study was to compare the incidence of DL infection using two different externalization techniques. Between July 1, 2008, and October 15, 2011, 125 consecutive patients underwent HeartMate II LVAD implant at a single institution. Patients that underwent implant in 2008-2009 (n = 45) had the velour portion of the DL externalized (Velour group) and those that were implanted in 2010-2011 (n = 80) had only the silicone portion externalized (Silicone group). Kaplan-Meier analysis with log-rank test was used to compare actuarial DL infection-free survival and a composite of death and DL infection-free survival. There were 20/45 (44.4%) DL infections in the Velour group compared with 7/80 (8.8%) in the Silicone group. Driveline infection-free survival was significantly better for the Silicone versus Velour group as was the composite end-point of death and infection-free survival (p < 0.001). Externalization of only the silicone portion of the DL led to a dramatic reduction in infections and significantly improved survival after implant. This represents an opportunity to decrease the incidence of this important cause of morbidity and mortality after LVAD implant.