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Ann Thorac Surg 2002;74:1267-1268
© 2002 The Society of Thoracic Surgeons

How to do it

Surgical management of Novacor drive-line exit site infections

Michael K. Pasque, MD*a, Tina Hanselman, RN, BSNc, Kim Shelton, RN, BSNc, Beth A. Kehoe-Huck, RN, BSNc, Robyn Hedges, RN, MSN, CNORc, Stephen D. Cassivi, MDa, Gregory A. Ewald, MDb, Joseph G. Rogers, MDb

a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
b Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA
c Division of Nursing Services, Barnes-Jewish Hospital, St. Louis, Missouri, USA

Accepted for publication April 30, 2002.

* Address reprint requests to Dr Pasque, Division of Cardiothoracic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 3108 Queeny Tower, St. Louis, MO 63110 USA
e-mail: pasquem{at}msnotes.wustl.edu

Implantable left ventricular assist device (LVAD) drive-line exit site infection, an expected consequence of currently available device use, continues to be a significant limiting factor in long-term support. We theorize that the mechanism behind the establishment of the most chronic exit site infections involves a shearing torsion injury that disrupts the tissue adherence interface with the drive-line. The resulting neo-epithelialized drainage tract prevents permanent clearance of the infection with antibiotics alone. The proposed treatment strategy of established infections involves aggressive surgical excision of the involved exit site.




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