The Pressure is on: Single Center's Experience with Negative Pressure Wound Therapy and Driveline Infection

Abstract

PurposeDelay or complete lack of integration with the HeartMate 3 (HM3) driveline has led to an increased incidence of driveline infection (DLI). Negative pressure wound therapy (NPWT) may be helpful in decreasing the rate of infection by facilitating integration, therefore we evaluated the possible benefits of a single use NPWT system (Prevena) on DLI outcomes (Figure 1).MethodsRetrospective chart review of primary HM3 patients implanted from January 2019 through October 2020. The INTERMACS 2016 definition of DLI was utilized. DLI outcomes were analyzed using Fisher's exact test. Freedom from DLI for the NPWT and non NPWT groups were analyzed using the Kaplan-Meier method.ResultsWithin the study period there was a total of 40 primary implants. Twenty- two patients were implanted between January 2019 and October 2019 (non NPWT group) and 18 patients were implanted between November 2019 and October 2020 (NPWT group). In the non NPWT group, 3 patients developed DLI in the first six months (14 %). In the NPWT group, 1 patient developed DLI in the first six months (6 %) (p = 0.512, Figure 2).Average length of time to infection in the NPWT group was 146 days vs 69.3 days in the non NPWT group. Although exit site diameter tended to be smaller with the NPWT approach, overall integration and mobility of the driveline in its transcutaneous track was similar.ConclusionIn a moderate size single center experience, use of a NPWT approach led to a decrease in DLI rate. Larger studies are needed to validate this finding. Delay or complete lack of integration with the HeartMate 3 (HM3) driveline has led to an increased incidence of driveline infection (DLI). Negative pressure wound therapy (NPWT) may be helpful in decreasing the rate of infection by facilitating integration, therefore we evaluated the possible benefits of a single use NPWT system (Prevena) on DLI outcomes (Figure 1). Retrospective chart review of primary HM3 patients implanted from January 2019 through October 2020. The INTERMACS 2016 definition of DLI was utilized. DLI outcomes were analyzed using Fisher's exact test. Freedom from DLI for the NPWT and non NPWT groups were analyzed using the Kaplan-Meier method. Within the study period there was a total of 40 primary implants. Twenty- two patients were implanted between January 2019 and October 2019 (non NPWT group) and 18 patients were implanted between November 2019 and October 2020 (NPWT group). In the non NPWT group, 3 patients developed DLI in the first six months (14 %). In the NPWT group, 1 patient developed DLI in the first six months (6 %) (p = 0.512, Figure 2).Average length of time to infection in the NPWT group was 146 days vs 69.3 days in the non NPWT group. Although exit site diameter tended to be smaller with the NPWT approach, overall integration and mobility of the driveline in its transcutaneous track was similar. In a moderate size single center experience, use of a NPWT approach led to a decrease in DLI rate. Larger studies are needed to validate this finding.