Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections

Barbara Cagliostro, Allison P. Levin, Justin Fried, Scott Stewart, Grant Parkis, Kanika P. Mody, Arthur R. Garan, Veli Topkara, Hiroo Takayama, Yoshifumi Naka, Ulrich P. Jorde, Nir Uriel

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Background Drive-line infection (DLI) is a common complication of left ventricular assist device (LVAD) support, leading to significant morbidity that jeopardizes the benefits of these devices. It has been reported that DLI incidence is related to drive-line dressing strategies. The aim of this study was to determine whether implementation of a standardized drive-line care kit would reduce the incidence of DLIs. Methods DLI data were collected prospectively on all LVAD patients implanted between 2009 and 2013 at Columbia University Medical Center. Drive-line care was altered on June 1, 2011, from a dry sterile dressing without a standard anchoring device to a standardized kit, which included silver gauze dressing and a standard anchoring device. The silver dressing was used until the wound incorporated, with a minimum of 1 month. Results During the study period, 107 patients were implanted with LVADs before implementation of a standardized kit (Group A) and 159 thereafter (Group B). Median follow-up time (censoring at June 2011) for Group A was 8.73 (IQR 3.51 to 17.47) months and 11.65 (IQR 6.66 to 35.20) months for Group B (p = 0.17). DLI event rate improved from 0.18 to 0.07 event per patient-year, corresponding to a relative risk reduction of 62.5%. In addition, the 1-year freedom from infection was significantly increased in Group B (92.46%) compared with Group A (81.94%) (log rank = 0.036). Conclusion The use of a standardized kit, including silver dressing and a standard anchoring device, leads to decrease in DLI with an absolute risk reduction of 11%. Routine use of these dressing techniques is warranted based on our findings, and may lead to reduction of complications related to infections.

Original languageEnglish (US)
Pages (from-to)108-114
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • CFLVAD
  • driveline
  • infection
  • kit
  • reduction
  • silver dressing

ASJC Scopus subject areas

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

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