A comprehensive diagnostic and therapeutic strategy for driveline infections in long-term mechanical circulatory support

Objective: to evaluate the clinical efficacy of a comprehensive approach to the diagnosis and surgical treatment of driveline infections (DLIs) in patients with long-term mechanical circulatory support (MCS).

Materials and methods. A single-center retrospective observational study was conducted at Shumakov National Medical Research Center of Transplantology and Artificial Organs. The analysis included 56 patients with implanted devices for long-term MCS of the left ventricle: AVK-N (2012–2018) – 17; Stream Cardio (2022–2025) – 32; HeartMate 3 (2022–2025) – 7 people.

Results. DLIs were identified in 18 of 56 patients (32.1%) with long-term left ventricular MCS. In the group managed without the diagnostic and therapeutic DLI algorithm, infections occurred in 8 of 17 patients (47.1%), whereas in the group managed with the algorithm, DLIs were detected in 10 of 39 patients (25.6%). Most DLI episodes developed within the first six months after device implantation. Implementation of the diagnostic and treatment algorithm resulted in a reduction in relapse frequency in patients with extensive forms of DLI (from 2.25 to 1.17 episodes per patient; p = 0.050) and a significant decrease in the duration of hospitalization for both local and subcutaneous forms (p = 0.022 and p = 0.014, respectively).

Conclusion. The use of the developed algorithm for the diagnosis and treatment of DLIs in patients receiving long-term MCS enabled a systematic approach to patient management, improved the effectiveness of local infection control, reduced hospital length of stay, and decreased the frequency of infectious complications.

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