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DOI: 10.1055/s-0029-1246746
Occasional intraabdominal tunnelling of driveline in patient supported over 4 year with DuraHeart left ventricular assist device (LVAD) detected at time of pumpexchange
Introduction: Long-term support with left ventricular assist devise could be limited by driveline infection, which may lead to detrimental complication as pocket infection, sepsis and sepsis-related coagulations disorders.
Case report: 63 old male multimorbid patient with ischemic cardiomyopathy undergone Dura Heart LVAD (Terumo Heart, Inc., Ann Arbor, Michigan, USA) implantation for permanent support. Postoperative course was uneventful, and the patient was discharged home being actively reintegrated in family life. Regularly visit in out-clinic department (once a 4–6 month) revealed no sings of driveline infection. After more then 3.5 years of support drive-line defect was discovered and successfully repaired in surgery stand by. At 1475 day being on LVAD definitive pump stop due to repeated drive-line damage occurred and patient undergone emergency device exchange.
After re-opening of the chest and dividing of intrathoracal adhesions pump were mobilized. During preparation of percutaneous lead surprisingly abdomen cavity was opened. Driveline was tunneled through abdomen cavity, were it was completely wrapped by omentum majus, located in front of liver and penetrated abdomen wall with skin exit in right iliac crest. No signs of ascending infection during mobilization of driveline from omentum tissue were observed. A new Dura Heart LVAD was reinserted and driveline tunnelled subcutaneously with skin exit site in the left iliac crest.
Discussion: In our case with occasional tunneling of Dura Heart LVAD driveline through abdomen space natural wrapping with omentum majus prevented ascending driveline infection over than 4 year of LVAD support.