Driveline angle is crucial for preventing driveline infection in patients with HeartMate II device

Yorihiko Matsumoto, Satsuki Fukushima, Yusuke Shimahara, Kizuku Yamashita, Naonori Kawamoto, Kensuke Kuroda, Osamu Seguchi, Masanobu Yanase, Norihide Fukushima, Hideyuki Shimizu, Junjiro Kobayashi, Tomoyuki Fujita

Research output: Contribution to journalArticle

Abstract

We hypothesized that the externalizing direction of the driveline (the driveline angle) at the percutaneous exit site would influence the occurrence of driveline infection after left ventricular assist device implantation. From August 2013 to May 2017, 71 patients were implanted with a HeartMate II device in our center. The driveline angle was measured on anteroposterior radiography just after implantation. Risk factors for driveline infection were analyzed by uni- and multivariate analyses. Driveline infection developed in 10 (14%) patients during follow-up. Overall actual freedoms from driveline infection at 6, 12, and 24 months were 96%, 88%, and 86%, respectively. Overall number of driveline infection events per patient-year was 0.16. Receiver operating characteristic analysis determined the cut-off point of the driveline angle as 41°. The 6-, 12-, and 24-month actuarial freedoms from driveline infection in those with driveline angle more than 42° (84%, 74%, and 74%, respectively) were significantly lower than in those with driveline angle less than 41° (97%, 94%, and 90%, respectively; p < 0.02). The numbers of driveline infection events per patient-year were 0.16 in patients with driveline angle more than 42°, and 0.04 in patients with driveline angle less than 41°. Multivariate analysis demonstrated that driveline angle more than 42° was an independent risk factor for driveline infection (hazard ratio 4.71). Driveline angle more than 42° is an independent risk factor for driveline infection in patients with HeartMate II. Externalization of the driveline toward the horizontal direction is important to prevent driveline infection with HeartMate II.

Original languageEnglish
JournalJournal of Artificial Organs
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Equipment and Supplies
Infection
Left ventricular assist devices
Radiography
Hazards
Multivariate Analysis
Heart-Assist Devices
Direction compound
ROC Curve

Keywords

  • Driveline infection
  • HeartMate II
  • Implant procedure
  • Implantable LVAD
  • Prevention

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering
  • Cardiology and Cardiovascular Medicine

Cite this

Matsumoto, Y., Fukushima, S., Shimahara, Y., Yamashita, K., Kawamoto, N., Kuroda, K., ... Fujita, T. (Accepted/In press). Driveline angle is crucial for preventing driveline infection in patients with HeartMate II device. Journal of Artificial Organs. https://doi.org/10.1007/s10047-018-1074-x

Driveline angle is crucial for preventing driveline infection in patients with HeartMate II device. / Matsumoto, Yorihiko; Fukushima, Satsuki; Shimahara, Yusuke; Yamashita, Kizuku; Kawamoto, Naonori; Kuroda, Kensuke; Seguchi, Osamu; Yanase, Masanobu; Fukushima, Norihide; Shimizu, Hideyuki; Kobayashi, Junjiro; Fujita, Tomoyuki.

In: Journal of Artificial Organs, 01.01.2018.

Research output: Contribution to journalArticle

Matsumoto, Y, Fukushima, S, Shimahara, Y, Yamashita, K, Kawamoto, N, Kuroda, K, Seguchi, O, Yanase, M, Fukushima, N, Shimizu, H, Kobayashi, J & Fujita, T 2018, 'Driveline angle is crucial for preventing driveline infection in patients with HeartMate II device', Journal of Artificial Organs. https://doi.org/10.1007/s10047-018-1074-x
Matsumoto, Yorihiko ; Fukushima, Satsuki ; Shimahara, Yusuke ; Yamashita, Kizuku ; Kawamoto, Naonori ; Kuroda, Kensuke ; Seguchi, Osamu ; Yanase, Masanobu ; Fukushima, Norihide ; Shimizu, Hideyuki ; Kobayashi, Junjiro ; Fujita, Tomoyuki. / Driveline angle is crucial for preventing driveline infection in patients with HeartMate II device. In: Journal of Artificial Organs. 2018.
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abstract = "We hypothesized that the externalizing direction of the driveline (the driveline angle) at the percutaneous exit site would influence the occurrence of driveline infection after left ventricular assist device implantation. From August 2013 to May 2017, 71 patients were implanted with a HeartMate II device in our center. The driveline angle was measured on anteroposterior radiography just after implantation. Risk factors for driveline infection were analyzed by uni- and multivariate analyses. Driveline infection developed in 10 (14{\%}) patients during follow-up. Overall actual freedoms from driveline infection at 6, 12, and 24 months were 96{\%}, 88{\%}, and 86{\%}, respectively. Overall number of driveline infection events per patient-year was 0.16. Receiver operating characteristic analysis determined the cut-off point of the driveline angle as 41°. The 6-, 12-, and 24-month actuarial freedoms from driveline infection in those with driveline angle more than 42° (84{\%}, 74{\%}, and 74{\%}, respectively) were significantly lower than in those with driveline angle less than 41° (97{\%}, 94{\%}, and 90{\%}, respectively; p < 0.02). The numbers of driveline infection events per patient-year were 0.16 in patients with driveline angle more than 42°, and 0.04 in patients with driveline angle less than 41°. Multivariate analysis demonstrated that driveline angle more than 42° was an independent risk factor for driveline infection (hazard ratio 4.71). Driveline angle more than 42° is an independent risk factor for driveline infection in patients with HeartMate II. Externalization of the driveline toward the horizontal direction is important to prevent driveline infection with HeartMate II.",
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