Driveline infection burden, management and prognosis in patients under durable LVAD support: a single-center experience with HeartMate 3
I Santos, A M Garcia, C Sampaio, M Presume, A R Bello, S Maltes, B Rocha, C Brizido, C Strong, M Marques, C AguiarAbstract
Background
Durable left ventricular assist device (LVAD) therapy has significantly improved survival and quality of life of advanced heart failure (AHF) patients. However, device-related complications such as driveline infections (DLI) remain a critical clinical challenge.
Purpose
To describe the epidemiology, microbiology, management strategies, and outcomes of driveline-related infections experienced by patients under LVAD with HeartMate 3™ (HM3).
Methods
Retrospective observational study including all patients implanted a HM3 between 2018 and 2025 and/or under HM3 follow-up at a single tertiary center. Patients on HM3 support for less than three months were excluded. Clinical data regarding DLI events, their management strategy and outcomes was collected. Descriptive statistics were performed.
Results
Twenty-four HM3 recipients were included (mean age 55.1 ± 11.3 years, 87.5% male), most implanted in a bridge-to-transplantation strategy (45.8%), and most with previous ischemic cardiomyopathy (58.3%). Recurrent non-compliance with driveline care instructions was observed in 25% of patients. Overall, 50% of HM3 recipients registered at least one DLI episode, with a total of 29 suspected DLI episodes during a mean follow-up of 31.1 ± 21.0 months and a median HM3 support duration of 19.0 months. Driveline exudate cultures were positive in 79.3% of cases. Gram-positive bacteria predominated, namely Staphylococcus aureus. Beta-lactams were the most frequently used antibiotics (AB), specifically oral flucloxacillin and i.v. piperacillin-tazobactam. Median AB duration was of 14 days. Associated bacteremia was only found in three cases and two patients were treated for HM3-related endocarditis. Chronic colonization was assumed in four cases. Long-term suppressive AB was needed in five cases. Hospitalization for DLI management was required in 48.3%. Invasive interventions, such as surgical debridement and driveline revision, occurred in five cases. There was one case of DLI-related death due to septic shock, and two urgent heart transplantation listings due to recurrent or refractory DLI.
Conclusion
In this HM3 cohort, DLI represented significant clinical burden, often requiring hospitalization and prolonged AB therapy. However, severe infections were relatively uncommon and invasive procedures were only needed in very select cases. These findings underline the need for optimized patient education and preventive strategies to reduce morbidity and improve long-term outcomes in HM3 recipients.