P60. Persistent LVAD Pocket and Driveline Site Infections after Orthotopic Heart Transplant Benefit from Surgical Management

PURPOSE: While chronic left ventricular assist device (LVAD) driveline infection is a common complication in patients who receive VAD implant as a bridge to transplant, infections typically resolve after orthotopic heart transplant (OHT) and LVAD explant. In this report we describe two patients with chronic antibiotic resistant LVAD driveline infections who presented with recurrent infection in their LVAD pocket and driveline site weeks after explant, complicating the healing of their corresponding thoracic and abdominal wounds. METHODS: The patient charts were reviewed retrospectively with patient consent. RESULTS: Both patients were male, middle aged and former smokers. Their past medical histories were both notable for obstructive sleep apnea, hypertension, and chronic kidney disease. After initial LVAD implantation, both patients developed chronic, multi-drug resistant Pseudomonas aeruginosa infection of their driveline site, which was managed using antibiotics and surgical debridement with cardiothoracic surgery. After LVAD explant both patients presented with infection in their previous driveline site 18 days later with cultures showing vancomycin-resistant Enterococcus faecium and Pseudomonas, respectively. Medical management of these infections was limited and both patients underwent definitive closure by plastic and reconstructive surgery approximately one week after onset of infection, utilizing serratus anterior muscle flaps to close their anterior chest wall wounds and rotational "yin-yang" fasciocutaneous flaps to close their driveline site wounds. Follow-up data show no evidence of recurrent infection since closure. CONCLUSION: These cases illustrate an effective strategy for managing an uncommon, atypical, post-OHT LVAD driveline site infections using a surgical debridement and closure.