Driveline Infection: Reroute or Not to Reroute, That is the Question

Purpose Driveline infections (DLIs) are common adverse events for pts on continued left ventricular assist device (LVAD) support. We present a single center investigation of surgical treatment for DLI including culprit organisms, reintervention rates, and days free from reinfection. Methods A review of our institutional LVAD database included all pts implanted from June 2015 to June 2020. DLIs were identified as a clinical or radiographical diagnosis and included in this cohort. Surgical treatment included incision, drainage and debridement (I&D) with or without driveline rerouting (DR) (see Figure 1). Baseline characteristics, DL exit site at time of implantation, time to first infection, reintervention, and freedom from reinfection were examined. Results 148 pts received an LVAD during the study period. 31(21%) pts developed DLI, and 20(65%) underwent surgical therapy. Of those undergoing surgery, mean age 59 years, 17(85%) male, average BMI 28.4 kg/m2, and 5(25%) were diabetic. 15(75%) pts were implanted as destination therapy. The implanted devices were Heartmate 3 (14), Heartmate II (5), and HeartWare HVAD (1). 6 pts had DL tunneled in right lateral abdomen and 14 in left. Pts with a left-sided DL, 10(71%) utilized a counterincision in the right abdomen. Time to first DLI following LVAD implant was on average 476 days (70-1089 days). Surgical intervention at first infection included 14 DR and 6 I&D. 9(45%) pts had recurrent DLI of which 2 required reintervention, a device exchange and a rerouting. Mean time for reinfection after rerouting was 230 days and 146 days following I&D. Freedom from repeat surgical intervention in 11 pts lasted on average 350 days (59-579 days). 4 pts underwent heart transplant. The most common bacteria were MSSA 6(30%), pseudomonas 5(20%), and MRSA 3(15%). Conclusion Driveline rerouting is a successful intervention to temporize and control a DLI. Compared to I&D, rerouting of the driveline may offer better freedom from reintervention. Further investigation into indications for rerouting is warranted.