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DOI: 10.1055/s-0032-1332340
Extended experience with the double tunnel driveline technique in LVAD patients
Objective: Driveline infections are still a major problem in patients treated with intrathoracic cardiac assist devices. We recently described a long subfascial, C shaped course of the driveline (double tunnel technique), which led to low infection rates and improved management of driveline problems 1.
Methods: In a period of 11 months we analyzed 15 consecutive LVAD patients at our non-cardiac-transplant center (2285 days of support). All implants were performed regarding our well-established double tunnel driveline technique.
Results: 13 of these 15 Patients (80%) are still on support. In the total observation period there was 1 superficial driveline infections (0.43/1000 patient-days), but no patient needed surgical revision due to driveline infection. However 2 patients developed early persistent secretion from the driveline exit, without evident signs of infection. The infectious diagnostics of the fluid formation along the driveline were all negative. These patients where treated successful with appliance of vacuum-assisted closure therapy at the lateral incision site of the driveline course. In one of these patients local redirection of the driveline exit was needed.
Conclusion: The double driveline technique continues to show promising results. Our results support the notion, that double tunnel driveline technique is a strategy to prevent deep driveline exit site infections. Seroma formation might be a problem in the early period. Thanks to the long subfascial course there are many possible strategies to treat this problem with reduced surgical demand.
Reference: 1. Schibilsky D, Benk C, Haller C, Berchtold-Herz M, Siepe M, Beyersdorf F, Schlensak C. Double tunnel technique for the LVAD driveline: improved management regarding driveline infections. J Artif Organs. 2011;