Advances in Driveline Technology Cures Some but Infects Others: Single Center's Experience with Driveline Infections in HeartMate 3 Patients

D. Fauvel, C. Castillo, M. Taveras, J. Oviedo, O. Saeed, S. Forest, D. J. Goldstein, S. R. Patel, U. Jorde

Research output: Contribution to journalArticle

Abstract

PURPOSE: To address the high incidence of driveline malfunction in the HeartMate II® (HM2), a shield less, polyurethane -insulated, and modular cable driveline was introduced into the HeartMate 3® (HM3). Because these modifications resulted in changes to the physical properties of the driveline, we sought to evaluate the impact of these putative improvements on the incidence of driveline infection (DLI). METHODS: Retrospective chart review of all HM2 and HM3 between 2015 and 2019. DLI was defined according to the INTERMACS 2016 definition. Patients with DLI were reviewed for clinical course including diagnosis, treatment, and outcomes. Data were analyzed using Kaplan-Meier methodology. RESULTS: Over the study period, 93 HM2 and 68 HM3 were implanted. DLI was diagnosed in 16% of HM2 patients vs. 21.7% of HM3 patients (p=0.14, figure 1). Average time to DLI was 428.2 days in HM2 vs 370.3 days in HM3. EPPY was 0.14 for HM2 vs. 0.23 for HM3. HM3 DLI tended to be more severe as evidenced by need for surgical intervention 80% vs. 40% (p < 0.001) and need for IV antibiotics greater than 10 days 73% vs. 33%.(p < 0.001). CONCLUSION: In this single center experience, HeartMate 3® patients develop infections with shorter support times and required more aggressive interventions. Anecdotally, our team has noted a delayed or lack of integration of skin to polyurethane after implantation. In response, we have implemented the following: dual adjustable anchor, cadexomer iodine for excessive drainage, showering without dressings, suture removal prior to patient discharge, and incorporating picture instructions in driveline dressing kits to facilitate adherence to sterile technique. At the time of presentation of this abstract, we anticipate sharing our outcomes with these new techniques.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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