Successful Cold Atmospheric Plasma Therapy of Driveline Infections in Patients with Left Ventricular Assist Devices

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<h3>Purpose</h3> Driveline infections are still the Achilles heel of continuous flow left ventricular assist devices (cfLVAD) for morbidity and mortality in cfLVAD patients. Over the last years, cold atmospheric plasma (CAP) has been safely and effectively used to treat wound infections in different clinical indications. Thus, in this study we evaluated CAP therapy of superficial driveline infections (SDI). <h3>Methods</h3> 24 patients (20male, 4 female), who received a cfLVAD between 2012 and 2018, developed a SDI. In total 30 CAP plasma jet treatments were applied, 16 patients were treated in hospital, 8 patients in the ambulance and 6 patients were treated in both. All wounds were treated with CAP starting from the day of diagnosis of SDI. <h3>Results</h3> The average number of CAP applications per case was 9.06 times (1-101), median duration of hospital stay due to SDI was 41.35 days (5-254). 21 patients were additional treated with antibiotics (70%). In 9 patients (30%) an ascending driveline infection (ADI) occurred, which required surgical revision. The 3 month event free survival was 21 patients (70 %). There were no adverse side effects of CAP therapy observed and there were no abnormalities of cfLVAD during CAP treatment. <h3>Conclusion</h3> We demonstrate that CAP therapy could be effectively and safely applied in cfLVAD patients with SDI. Using CAP 70% of our cases with SDI were prevented from ADI. Future studies have to show if ambulant CAP therapy of superficial cfLVAD wound infections has the potential to prevent progression of infection or to avoid SDI infection at all.