Reduction of Driveline Infections through Doubled Driveline Tunneling of Left Ventricular Assist Devices—Five-Year Follow-up

Objectives: Driveline infection (DLI) is one of the leading causes for unplanned re-admissions of patients undergoing therapy with left ventricular assist devices (LVAD). In previous studies our group was able to show that a double tunneling implantation technique could significantly reduce infection rates one year after implantation. We now report the results of the five-year-follow up of patients receiving the double tunneling technique.

Methods: We retrospectively analyzed patients receiving LVAD therapy with the HVAD (HeartWare, Inc., Miami Lakes, FL, USA) LVAD. By For 36 patients (group 1) the driveline was tunneled via a conventional technique. In the Other remaining 33 patients (group 2) were implanted at the drivelines were implanted by means of a double tunneling technique. The double tunnel driveline technique included involved placement of the driveline in the sheath of the rectus muscle in the umbilical direction and then subcutaneously to the left (alternatively right) upper quadrant. We retrospectively compared both groups. Primary outcome parameters were infection rate and mortality.

Results: Five years after LVAD implantation the driveline infection rate of patients operated by a double tunneling technique was significantly lower than in the conventional technique group (61% [n = 22] group 1 vs. 30% [n = 10] group 2, p = 0.004). The five-year mortality was lower in group 2 (42% [n = 15] group 1 vs. 27% [n = 9] group 2) but did not reach achieve a statistical significance (p = 0.10). The days of LVAD support between the two groups were comparable (1,275.55 ± 885.89 in group 1 vs. 1,321.93 ± 711.37 in group 2). The tunnel technique itself showed to be strongly associated with the occurrence of DLI. Other elevated variables are liver disease and dilated cardiomyopathy as primary disease.

Conclusion: Double tunneling technique for driveline implantation leads to significantly lowered infection rates after five years of LVAD therapy and it is associated with a lower mortality.

No conflict of interest has been declared by the author(s).