Photodynamic Antimicrobial Chemotherapy in LVAD-Driveline Infections: Initial Single-Center Experience

Objectives: Driveline-exit infection (DEI) is the most frequent long-term complication in left ventricular assist device (LVAD) patients and effects prognosis and quality of life. An effective local therapy of DEI is not available, and progressive DEI frequently leads to revisions or even pump-changes. We investigated feasibility, safety and effectiveness of local photodynamic antimicrobial chemotherapy (PACT) of DEI.

Methods: Tolonium chloride generates reactive oxygen species when photo-activated. We performed PACT in eight LVAD patients in our outpatient clinic: the driveline exit site was impregnated with sterile tolonium chloride (TBO) gel and irradiated for 10 minutes with monochromatic LED-Light of 630 nm, 10 W. After removal of the gel, the driveline exit was draped sterilely. The treatment was repeated weakly, six times, additionally to the standard treatment, wounds were documented photographically. The results were compared with 12 patients with DEI receiving the standard treatment consisting of oral antibiotics, daily antiseptic treatment, and silver-based wound dressing.

Results: Three of eight LVAD patients treated with PACT reported a mild local redness, besides that, we recognized no local or systemic side effects. No deterioration of the DEI was observed during treatment. Two patients from the PACT group underwent surgical driveline revision and one patient underwent pump-change in the further course. The other five patients had no signs of DEI 6 months after the therapy. In the standard treatment group, 9 of 12 patients underwent surgical driveline revisions within 6 months after diagnosis.

Conclusion: PACT is a feasible and safe method in the ambulatory treatment of DEI of LVAD patients. In this initial single-center experience, PACT was not inferior to the conventional standard treatment of DEI, consisting of antibiotics and local antiseptic therapy, and we observed a clear tendency to a lower need for surgical driveline revisions. PACT has been shown to be effective in other clinical disciplines and appears to be a promising therapy concept for DEI in LVAD patients. We are planning to undertake a larger study to investigate its effectiveness.