Driveline-related infections after left ventricular assist device implantation: A single center experience

Year 2019, Volume: 10 Issue: 3, 377 - 383, 30.09.2019

Sinan Sabit Kocabeyoğlu Doğan Emre Sert

https://doi.org/10.18663/tjcl.617027

Abstract

Aim:
The
most common complication after left ventricular assist device
implantation is driveline-induced infections. This complication
severely deteriorates quality of life of the patients. The aim of
this study was to investigate driveline infections in patients with
left ventricular assist device and to introduce our treatment
strategy.

Material
and Methods: Between
May 2013 and October 2018, 90 adult patients who underwent left
ventricular assist device implantation were included. Driveline
infection rates, characteristics, pathogen microorganisms were
investigated. Treatment options for infections were also analyzed.

Results:
The
mean age of the patients was 46.3 ± 13.7 and 83.3% (75/90) were
male. Dilated cardiomyopathy was present in 62.2% of the patients.
Driveline infection was detected in 35.5% (32/90) of the patients.
The mean time between implantation and driveline infection was 304 ±
309 (15-1500) days. The most commonly detected microorganisms from
swabs and/or tissue cultures were gram positive cocci. Seven patients
required oral antibiotic treatment whereas 25 patients required
systemic antibiotic treatment. While infection was controlled by
oral/systemic antibiotic therapy in 13 patients, 15 patients
underwent surgical debridement, three patients required translocation
and heart transplant was required in one patient. None of the
patients had uncontrolled infection requiring device extraction.

Conclusion:
Left
ventricular assist device implantation carries high risk of driveline
infection; In this study, the rate was found to be 24.4% in the first
year. Infection was controlled by oral or systemic antibiotic therapy
and/or debridement therapy in selected cases, driveline translocation
and heart transplant were rarely required.

Keywords

Left ventricular assist device, driveline infection, exit site.

Sol ventrikül destek cihazı implantasyonu sonrası driveline ile ilişkili enfeksiyonlar: Tek merkez deneyimi

Abstract

Amaç:
Sol
ventrikül destek cihazı sonrası görülen en sık komplikasyon
driveline kaynaklı enfeksiyonlardır. Bu komplikasyon hastaların
hayat kalitesini ileri derecede bozmaktadır. Bu çalışmanın amacı
sol ventrikül destek cihazı takılan hastalarda driveline
enfeksiyonlarını araştırmak ve tedavi stratejimizi ortaya
koymaktır.

Gereç
ve Yöntemler: Mayıs
2013 ile Ekim 2018 tarihleri arasında sol ventrikül destek cihazı
takılan 90 erişkin hasta çalışmaya dahil edildi. Driveline
enfeksiyon oranları, özellikleri, patojen mikroorganizmalar
araştırıldı. Ayrıca enfeksiyonlara karşı uygulanan tedavi
seçenekleri incelendi.

Bulgular:
Hastaların
ortalama yaşları 46,3 ± 13,7 idi ve %83,3’ ü (75/90) erkekti.
Hastaların %62,2’ sinde dilate kardiyomiyopati mevcuttu. Tüm
hastaların %35,5’inde (32/90) driveline enfeksiyonu tespit edildi.
İmplantasyon ve driveline enfeksiyonu görülme arasında geçen
ortalama süre 304±309(15-1500) gündü.
Alınan
sürüntü ve/veya doku kültürlerinde en çok tespit edilen
mikroorganizmalar gram pozitif koklar idi. Yedi hastada oral
antibiyotik,
25 hastada ise hastaneye yatırılarak sistemik
antibiyotik tedavisine gereksinim duyuldu. On üç hastada
oral/sistemik antibiyotik tedavisi ile enfeksiyon kontrol altına
alırken 15 hastada ise cerrahi olarak debridman yapıldı, üç
hastada driveline daha yukarı bir bölgeye taşındı ve bir hastaya
kalp nakli gerekti. Hiçbir hastada cerrahi olarak cihazın
çıkarılmasını gerektirecek kontrolsüz enfeksiyona rastlanmadı.

Sonuç:
Sol
ventrikül destek cihazları yüksek oranda driveline enfeksiyonu
oranlarına sahiptir; bu çalışmada oran 1. yılda %24,4 olarak
bulunmuştur. Oral veya sistemik antibiyotik tedavisi ile ve/veya
seçilmiş vakalarda debridman tedavisi ile enfeksiyon kontrol altına
alınmış, nadiren driveline kablosunun taşınması ve kalp nakline
ihtiyaç duyulmuştur.

Keywords

Sol ventrikül destek cihazı, driveline enfeksiyonu, çıkış yeri.

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