LVAD POWER DELIVERY - A PERCUTANEOUS APPROACH TO AVOID INFECTION

Background. Driveline infection limits the event-free survival of pati ents with a left ventricular assist device. With the evolving prospect of improved left ventricular assist devices in the bridge-to-transpla ntation or recovery setting, we sought to reduce the risk of driveline complications. Methods. As part of the Oxford Jarvik 2000 research pr ogram, we developed a carbon and then titanium pedestal to transmit th e electric wires through the skin. In a sheep model, the pedestal was brought out through the skin of the shoulder (n = 10) or the scalp (n = 9) with underlying fixation to the skull. Exit wounds were carefully inspected for healing and infection. Power cable durability tests wer e performed in 6 additional animals without an implanted pump. Results . The cumulative observation period was 1,491 days (mean time, 78 days ; range, 14 days to 198 days). There was no difference in observation period between the two groups. Infection (n = 2) and impaired healing (n = 5) occurred in the mobile tissues at the shoulder. Skull-mounted pedestals were free from infection or healing problems. The electric c ables were not interrupted by repeated neck flexion (cumulative observ ation period, 588 days). The carbon pedestal was replaced by a titaniu m pedestal when the head butting of the sheep fractured the carbon. Co nclusions. The combination of rigid fixation and highly vascular scalp skin reduces the risk of percutaneous driveline infection and may sol ve an important outstanding problem in use of left ventricular assist devices. (C) 1998 by The Society of Thoracic Surgeons.