Abstract
Infection is the most common complication in patients undergoing ventricular assist
device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent
VAD infection and is a significant cause of adverse events in VAD patients, contributing
to morbidity, even mortality, and repetitive hospital readmissions. There are many
risk factors for driveline infection (DLI) including younger age, smaller constitution
of patients, obesity, exposed velour at the DLES, longer duration of device support,
lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such
as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI
depends also on the device type. Numerous measures to prevent DLI currently exist.
Some of them are proven, whereas the others remain controversial. Current recommendations
on DLES care and DLI management are predominantly based on expert consensus and clinical
experience of the certain centers. However, careful and uniform DLES care including
obligatory driveline immobilization, previously prepared sterile dressing change kits,
and continuous patient education are probably crucial for prevention of DLI. Diagnosis
and treatment of DLI are often challenging because of certain immunological alterations
in VAD patients and microbial biofilm formation on the driveline surface areas. Although
there are many conservative and surgical methods described in the DLI treatment, the
only possible permanent solution for DLI resolution in VAD patients is heart transplantation.
This systematic review brings a comprehensive synthesis of recent data on the prevention,
diagnostic workup, and conservative and surgical management of DLI in VAD patients.
Keyword
cardiac - circulatory assist devices - infection - heart failure - wound healing -
wound infection
