The Effect of Percuatneous Lead Placement on Drive Line Exit Site Infections in HeartMate II Patients

Abstract

Purpose It has been suggested that aligning the junction of the silicon exterior of the HeartMate II drive line and the flocked portion of the lead with skin level, “Buried”, as opposed to leaving 2-3 inches of the flocking exposed above the skin, “Unburied” reduced DLES infections. Thus, we examined DLES infection rates and causes in a single center, retrospective, non-randomized review. Methods and Materials We compared DLES infection incidence, cause of infection (poor wound healing vs. trauma), time to 1st infection, requirement for advanced measures with the 2 DLES placements in Thoratec HeartMate II recipients. Statistical comparisons were performed using Statica (Statsoft). For this study, we defined a DLES infection as at least one positive wound culture. Results Figure 1 shows the freedom from DLES infections for the 2 approaches. Significantly more, 33% (16/48)) of Unburied had DLES infections than 18% (17/94) of Buried, and the infection duration was longer, 500 vs. 175 days, respectively. The average time to 1st infection was significantly longer, 13 months, for the Unburied vs 7 months for the Buried, related to cause of infection: poor wound healing in 59% of the Buried DLES infections (10/17) vs. 38% (6/16) for the Unburied. Of the 16 Unburied DLES infections, 11 required wound vac, 7 surgical revision, and 3 pump replacements, vs. 9, 7, and 0 respectively for the Buried approach. Conclusions Using the Buried approach may reduce the incidence, severity, and duration of DLES infection, yet, a portion of patients still develop DLES due to poor wound healing and trauma. Alternative approaches to the drive line are likely needed to eliminate this pernicious source of LVAD infections.