Abstract 14742: Driveline Infections Are Associated with Increased Hospitalizations Amongst Heartmate III Recipients

Introduction: The Heartmate III (Abbott, Chicago) is the only currently available durable left ventricular assist device (LVAD). Driveline infections (DLI) are a potential complication of durable mechanical circulatory support (MCS). We sought to analyze the impact of driveline infections on post-implantation outcomes. Methods: Consecutive patients who underwent implantation of a Heartmate III LVAD at our institution were analyzed. Patients were excluded if the device was placed as part of an exchange for another durable MCS device. Patients were followed until transplant, device exchange, death, or end of follow up. The primary outcome was the difference in number of hospitalizations and days hospitalized between patients with driveline infections compared to those without. Results: 130 patients (average age 59 years, 71% male) underwent implantation of a Heartmate III LVAD between September 2015 and March 2021. Over an average follow up of 23 months, 51 patients developed a documented DLI. The average time to DLI was 336 days. 90 percent of the initial DLI were caused by single organisms and 53 percent of these organisms were gram-positive. The number of total hospitalizations (2.6 vs. 5.9, p=0.00001) and total days hospitalized (28.8 vs. 62.7, p=0.0002) were increased in patients with DLI. Patients with DLI spent an average of 27 days hospitalized for reasons related to their DLI. 23 percent of patients with DLI required extended treatment with IV antibiotics for their first infection. 31 percent of patients with DLI were later transitioned from oral to extended treatment with intravenous antibiotics. 16 patients with DLI required debridement and 5 ultimately required device exchange. Conclusions: Despite improvement in device design and hemocompatibility, driveline infections remain a common source of morbidity for patients supported by Heartmate 3 LVAD and are associated with increased hospitalizations and hospitalization days. The potential morbidity should be discussed with patients prior to implantation and diligent care must be taken post-implantation to reduce the impact of this common complication.