FOCUS ON DRIVELINE MANAGEMENT TO REDUCE INFECTION RATES IN PATIENTS WITH VENTRICULAR ASSIST DEVICES (VAD): A NARRATIVE LITERATURE REVIEW

Abstract Background/Introduction The ventricular assist device (VAD) represents an essential therapeutic solution for patients with advanced heart failure. However, among the complications, driveline infections (DLI) are the most common and severe, with an incidence of up to 85%. The management of the driveline exit site plays a fundamental role in reducing infections, improving patients‘ quality of life, and clinical outcomes. Objective of the study This review aims to identify the most effective strategies for dressing the driveline exit site, with a particular focus on reducing the incidence of infections in patients with VADs. Study Population: Patients with ventricular assist devices (VAD). Materials and Methods The search was conducted in two databases, PubMed and Web of Science, analyzing articles published between 2018 and 2024. Six studies were included: five systematic reviews and one retrospective study, selected based on the quality of evidence and relevance to the topic. Results The results highlight chlorhexidine as the most effective disinfectant, followed by povidone–iodine used in patients with intolerance. Silver–based dressings, combined with transparent dressings and anchoring devices, have shown to reduce infection rates by 62.5%. Conversely, less advanced dressings, such as “Excilon 5x5®,“ increased the risk of infection by 27.7%. Identified risk factors include pulsatile flow devices, exposure of the driveline‘s velour portion, and elevated body mass index (BMI). While heart transplantation remains the only definitive solution, conservative techniques and optimal dressing methods are essential tools in managing DLIs. Conclusions Currently, there is no standardized protocol for driveline management. However, this review emphasizes the importance of driveline care, utilizing chlorhexidine, silver–based dressings, and anchoring devices to significantly reduce the incidence of DLI. Effective management not only patients‘ quality of life but also enhances the longevity and efficacy of the VAD.