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Erschienen in: Journal of Artificial Organs 1/2018

07.10.2017 | Original Article

Left ventricle assist devices and driveline’s infection incidence: a single-centre experience

verfasst von: Jonida Bejko, Francesca Toto, Dario Gregori, Gino Gerosa, Tomaso Bottio

Erschienen in: Journal of Artificial Organs | Ausgabe 1/2018

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Abstract

Different left ventricular assist devices (LVADs) are provided of different driveline exit sites: HeartWare HVAD presents abdominal power-cable-supply, while the Jarvik 2000 LVAD is powered by a retroauricular driveline. We analyzed 93 LVAD-implanted patients from January-2009 to October-2016 (41 HeartWare and 52 Jarvik 2000), hypothesizing a different incidence of infection, according to driveline exit site. The two populations were propensity matched for the demographic data and preoperative variables, and the outcomes were further analyzed. Nine driveline infections (DLIs) were in each LVAD group recorded (22% for HVAD and 17% for Jarvik 2000). The incidence of the complication was similar between groups (p = 0.97), even during time (p = 0.27 within 6 months and p = 0.16 over 6 months of support). Age at implant (p = 0.01), revision for bleeding (p = 0.05), days of postoperative intubation (p = 0.002), and ICU stay (p < 0.001), as well as days on device (p < 0.001) were identified as risk factors for DLIs. The type of device and the driveline exit site were not statistically co-related to infections. Similar infection-freedom survival was identified (p = 0.87). Younger age at implant, revision for bleeding, prolonged mechanical ventilation, delayed rehabilitation, as well as long time LVAD support were identified as risk factors for exit site DLIs. Despite similar incidence of DLIs, the different management and care of the retroauricular exit site makes it more appropriate and comfortable in long-term support.
Literatur
1.
Zurück zum Zitat Kormos RL, Borovetz HS, Armitage JM, Hardesty RL, Marrone GC, Griffith BP. Evolving experience with mechanical circulatory support. Ann Surg. 1991;214:471–6 (discussion 476-7).CrossRefPubMedPubMedCentral Kormos RL, Borovetz HS, Armitage JM, Hardesty RL, Marrone GC, Griffith BP. Evolving experience with mechanical circulatory support. Ann Surg. 1991;214:471–6 (discussion 476-7).CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Petri WA Jr. Infections in heart transplant recipients. Clin Infect Dis. 1994;18:141–6 (Quiz 147-8).CrossRefPubMed Petri WA Jr. Infections in heart transplant recipients. Clin Infect Dis. 1994;18:141–6 (Quiz 147-8).CrossRefPubMed
3.
Zurück zum Zitat Jarvik R, Westaby S, Katsumata T, Pigott D, Evans RD. LVAD power delivery. A percutaneous approach to avoid infection. Ann Thorac Surg. 1998;65:470–3.CrossRefPubMed Jarvik R, Westaby S, Katsumata T, Pigott D, Evans RD. LVAD power delivery. A percutaneous approach to avoid infection. Ann Thorac Surg. 1998;65:470–3.CrossRefPubMed
4.
Zurück zum Zitat Siegenthaler MP, Martin J, Pernice K, Doenst T, Sorg S, Trummer G, Friesewinkel O, Beyersdorf F. The Jarvik 2000 is associated with less infections than the HeartMate left ventricular assist device. Eur J Cardiothorac Surg. 2003;23:748–55.CrossRefPubMed Siegenthaler MP, Martin J, Pernice K, Doenst T, Sorg S, Trummer G, Friesewinkel O, Beyersdorf F. The Jarvik 2000 is associated with less infections than the HeartMate left ventricular assist device. Eur J Cardiothorac Surg. 2003;23:748–55.CrossRefPubMed
5.
Zurück zum Zitat Bottio T, Bejko J, Gallo M, Bortolussi G, Gerosa G. Less invasive implantation of HeartWare left ventricular assist device. Multimed Man Cardiothorac Surg. 2014. doi:10.1093/mmcts/mmu008. Bottio T, Bejko J, Gallo M, Bortolussi G, Gerosa G. Less invasive implantation of HeartWare left ventricular assist device. Multimed Man Cardiothorac Surg. 2014. doi:10.​1093/​mmcts/​mmu008.
6.
Zurück zum Zitat Bejko J, Guariento A, Bortolussi G, Tarzia V, Gerosa G, Bottio T. Minimally invasive surgical Jarvik 2000 off-pump implantation. Multimed Man Cardiothorac Surg. 2015. doi:10.1093/mmcts/mmv020. Bejko J, Guariento A, Bortolussi G, Tarzia V, Gerosa G, Bottio T. Minimally invasive surgical Jarvik 2000 off-pump implantation. Multimed Man Cardiothorac Surg. 2015. doi:10.​1093/​mmcts/​mmv020.
7.
Zurück zum Zitat Bottio T, Bejko J, Guariento A, Tarzia V, Pittarello D, Gerosa G. Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia. J Cardiovasc Med (Hagerstown). 2016;17:160–4.CrossRef Bottio T, Bejko J, Guariento A, Tarzia V, Pittarello D, Gerosa G. Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia. J Cardiovasc Med (Hagerstown). 2016;17:160–4.CrossRef
8.
Zurück zum Zitat Bortolussi G, Lika A, Bejko J, Gallo M, Tarzia V, Gerosa G, Bottio T. Left ventricular assist device end-to-end connection to the left subclavian artery: an alternative technique. Ann Thorac Surg. 2015;100:e93–5.CrossRefPubMed Bortolussi G, Lika A, Bejko J, Gallo M, Tarzia V, Gerosa G, Bottio T. Left ventricular assist device end-to-end connection to the left subclavian artery: an alternative technique. Ann Thorac Surg. 2015;100:e93–5.CrossRefPubMed
9.
Zurück zum Zitat Gallo M, Bortolussi G, Bejko J, Tarzia V, Gerosa G, Bottio T. How to remove the retroauricular driveline in the Jarvik 2000 after heart transplantation. Int J Artif Organs. 2016;39:45–7.CrossRefPubMed Gallo M, Bortolussi G, Bejko J, Tarzia V, Gerosa G, Bottio T. How to remove the retroauricular driveline in the Jarvik 2000 after heart transplantation. Int J Artif Organs. 2016;39:45–7.CrossRefPubMed
10.
Zurück zum Zitat Bejko J, Tarzia V, Gerosa G, Bottio T. Use of the Jarvik 2000 to facilitate left ventricular assist device placement in challenging apex anatomy. J Heart Lung Transpl. 2016;35:1049–51.CrossRef Bejko J, Tarzia V, Gerosa G, Bottio T. Use of the Jarvik 2000 to facilitate left ventricular assist device placement in challenging apex anatomy. J Heart Lung Transpl. 2016;35:1049–51.CrossRef
11.
Zurück zum Zitat Gerosa G, Gallo M, Tarzia V, Di Gregorio G, Zanella F, Bottio T. Less invasive surgical and perfusion technique for implantation of the Jarvik 2000 left ventricular assist device. Ann Thorac Surg. 2013;96:712–4.CrossRefPubMed Gerosa G, Gallo M, Tarzia V, Di Gregorio G, Zanella F, Bottio T. Less invasive surgical and perfusion technique for implantation of the Jarvik 2000 left ventricular assist device. Ann Thorac Surg. 2013;96:712–4.CrossRefPubMed
12.
Zurück zum Zitat Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, Schueler S, Holman WL, Lawler LP, Gordon SM, Mahon NG, Herre JM, Gould K, Montoya JG, Padera RF, Kormos RL, Conte JV, Mooney ML. International Society for Heart and Lung Transplantation. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transpl. 2011;30:375–84.CrossRef Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, Schueler S, Holman WL, Lawler LP, Gordon SM, Mahon NG, Herre JM, Gould K, Montoya JG, Padera RF, Kormos RL, Conte JV, Mooney ML. International Society for Heart and Lung Transplantation. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transpl. 2011;30:375–84.CrossRef
13.
Zurück zum Zitat Sharma V, Deo SV, Stulak JM, Durham LA 3rd, Daly RC, Park SJ, Baddour LM, Mehra K, Joyce LD. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg. 2012;94:1381–6.CrossRefPubMed Sharma V, Deo SV, Stulak JM, Durham LA 3rd, Daly RC, Park SJ, Baddour LM, Mehra K, Joyce LD. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg. 2012;94:1381–6.CrossRefPubMed
14.
Zurück zum Zitat Pereda D, Conte JV. Left ventricular assist device driveline infections. Cardiol Clin. 2011;29:515–27.CrossRefPubMed Pereda D, Conte JV. Left ventricular assist device driveline infections. Cardiol Clin. 2011;29:515–27.CrossRefPubMed
15.
Zurück zum Zitat Akhter SA, Badami A, Murray M, Kohmoto T, Lozonschi L, Osaki S, Lushaj EB. Hospital readmissions after continuous-flow left ventricular assist device implantation: incidence, causes, and cost analysis. Ann Thorac Surg. 2015;100:884–9.CrossRefPubMed Akhter SA, Badami A, Murray M, Kohmoto T, Lozonschi L, Osaki S, Lushaj EB. Hospital readmissions after continuous-flow left ventricular assist device implantation: incidence, causes, and cost analysis. Ann Thorac Surg. 2015;100:884–9.CrossRefPubMed
16.
Zurück zum Zitat Centofanti P, Attisani M, Bosco GF, Khayat A, La Torre M, Baronetto A, Boffini M, Rinaldi M. Successful replacement of a detached pedestal during support with Jarvik 2000. Int J Artif Organs. 2012;35:152–5.CrossRefPubMed Centofanti P, Attisani M, Bosco GF, Khayat A, La Torre M, Baronetto A, Boffini M, Rinaldi M. Successful replacement of a detached pedestal during support with Jarvik 2000. Int J Artif Organs. 2012;35:152–5.CrossRefPubMed
17.
Zurück zum Zitat Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Ewald GA, Shelton K, Pasque MK, Moon MR, Damiano RJ Jr, Moazami N. Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg. 2007;84:515–20.CrossRefPubMed Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Ewald GA, Shelton K, Pasque MK, Moon MR, Damiano RJ Jr, Moazami N. Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg. 2007;84:515–20.CrossRefPubMed
18.
Zurück zum Zitat Califano S, Pagani FD, Malani PN. Left ventricular assist device-associated infections. Infect Dis Clin N Am. 2012;26:77–87.CrossRef Califano S, Pagani FD, Malani PN. Left ventricular assist device-associated infections. Infect Dis Clin N Am. 2012;26:77–87.CrossRef
19.
Zurück zum Zitat Meszaros K, Fuehrer U, Grogg S, Sodeck G, Czerny M, Marschall J, Carrel T. Risk factors for sternal wound infection after open heart operations vary according to type of operation. Ann Thorac Surg. 2016;101:1418–25.CrossRefPubMed Meszaros K, Fuehrer U, Grogg S, Sodeck G, Czerny M, Marschall J, Carrel T. Risk factors for sternal wound infection after open heart operations vary according to type of operation. Ann Thorac Surg. 2016;101:1418–25.CrossRefPubMed
20.
Zurück zum Zitat Goldstein DJ, Naftel D, Holman W, Bellumkonda L, Pamboukian SV, Pagani FD, Kirklin J. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transpl. 2012;31:1151–7.CrossRef Goldstein DJ, Naftel D, Holman W, Bellumkonda L, Pamboukian SV, Pagani FD, Kirklin J. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transpl. 2012;31:1151–7.CrossRef
Metadaten
Titel
Left ventricle assist devices and driveline’s infection incidence: a single-centre experience
verfasst von
Jonida Bejko
Francesca Toto
Dario Gregori
Gino Gerosa
Tomaso Bottio
Publikationsdatum
07.10.2017
Verlag
Springer Japan
Erschienen in
Journal of Artificial Organs / Ausgabe 1/2018
Print ISSN: 1434-7229
Elektronische ISSN: 1619-0904
DOI
https://doi.org/10.1007/s10047-017-0997-y

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