Contact dermatitis and risk of driveline infection in patients with a left ventricular assist device

Abstract Background Driveline infection is a common complication in patients implanted with a left ventricular assist device (LVAD) and regular driveline exit-site care is essential for infection prevention. However, patients with a history of contact dermatitis (CD) may be more prone to driveline infection due to skin integrity disruptions. Particularly around the driveline exit, these disruptions can be triggered by the use of dressing-kits, cleaning agents, anchoring devices or other environmental allergens. Aim This single-center study aimed to assess whether LVAD patients with CD have a higher risk of driveline infection than those without CD. Methods Medical records of patients who were implanted with a HeartMate 3 (HM3) LVAD before January 1, 2025, were reviewed for driveline infection and CD. Driveline infection was defined as a VAD-specific infection involving the driveline, inflow graft, pump cannula or outflow graft. CD was defined as a history of allergy or irritation caused by contact with any foreign substance such as wound dressing, cleaning agents, medical adhesives, or other allergic materials and substances. Results A total of 169 patients implanted with a HM3 were included. The mean age of the population was 54.3 (SD = 12.4) years and 128 (75.7%) were male. Contact dermatitis was present in 79 (46.7%) patients. VAD-specific infection occurred in 61 (36.1%) patients. The median time to driveline infection was 13.9 (1.8-67.1) months. The incidence of driveline infection was significantly higher in patients with CD (48.1% vs. 25.6%; p=0.002). Time to driveline infection tended to be shorter in patients with CD compared to cases without CD (13.4 months vs. 14.3 months; p=0.060). Multivariable Cox regression analysis revealed male gender (HR:2.36, 95%CI:1.12-4.98) and presence of CD (HR:2.34, 95%CI:1.39-3.94) were found to be predictors of driveline infection (Table 1). The incidence of driveline infection recurrence was comparable in patients with and without CD (57.9% vs. 52.2%; p=0.55) (Fig 1). Median time to recurrence was also similar across the groups (11.4 months vs. 8.7 months; p=0.345). Conclusions In left ventricular assist device (LVAD) patients, the incidence of driveline infection is significantly higher in patients with a history of contact dermatitis (CD) compared to patients without a history of CD. Therefore, early detection and possibly proactive treatment of CD may prevent driveline infection. In addition, candidates for LVAD implantation should be proactively screened for a history of CD to allow for the selection of appropriate wound dressing materials that are free of allergenic agents.Cox regression analysis Incidence of DLI recurrence