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Novel driveline route for prevention from driveline infection: Triple tunnel method.

Abstract：

BACKGROUND:The most prevalent and serious infection related to left ventricular assist devices (LVADs) is driveline infection (DLI). From 2014, we employed a revised surgical technique (triple tunnel method), which deployed a longer subfascial driveline (DL) route. METHODS AND PATIENTS:We retrospectively analyzed 34 patients fitted with either of the two types of axial pumps: HeartMate II (n=23) and Jarvik 2000 (n=11). Prior to 2014, the DL proceeded from the pump pocket just above the posterior sheath of the rectus muscle toward a vertical skin incision at the right lateral border of the rectus muscle. Then, DL was turned leftward into the subcutaneous tissue to redirect its exit to the left side [subcutaneous tissue group (Group S): n=14]. From 2014, we made an additional skin incision below the umbilicus with the aim of lengthening the subfascial DL route [muscle group (Group M): n=20]. RESULTS:DLI occurred in 10 patients (71.4%) in Group S and in 1 patient (5%) in Group M (p<0.05, Chi-square test). The freedom rate from re-admission at 1 year due to DLI was 64% in Group S and 95% in Group M, respectively (p=0.021, log-rank test). Furthermore, logistic regression analysis revealed that DL route was significantly associated with DLI (odds ratio, 10.1; 95% confidence interval, 1.15-275.3). CONCLUSION:Although a longer follow-up period will be needed, the triple tunnel method may be beneficial in the prevention of DLI.

journal_name

J Cardiol

journal_title

Journal of cardiology

authors

Yoshitake S,Kinoshita O,Nawata K,Hoshino Y,Itoda Y,Kimura M,Yamauchi H,Ono M

doi

10.1016/j.jjcc.2018.04.003

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

363-366

issue

4

eissn

0914-5087

issn

1876-4738

pii

S0914-5087(18)30109-6

journal_volume

72

pub_type

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