My Life at 9200 rpm's: the dreaded driveline infection

LVAD #8358, my HeartMate II, is performing as designed, keeping me going, and giving me the opportunity to be on the waiting list for a heart transplant at the University of Minnesota.  

For the last 32 months with an LVAD I escaped a driveline infection, but I'm battling one now. Who knows what happened?  Even with a heightened awareness of the potential for infection, bacteria can cause problems. The driveline exits the abdomen of LVADs and it is treated as a wound site, with sterile dressing changes at regular intervals.

I have read and have been told that a site infection is quite common in LVAD implants because the wound site is tender and susceptible to tears.  Essentially the driveline is unsecured except for external Velcro tabs that hold it in place on an elastic binder.  The binder is used to hold the wound dressing in place and as a place to attach Velcro tabs to immobilize the driveline after it exits my abdomen. Immobilization is a relative term because the driveline can still be moved or tugged.


At any rate, the seal at the wound site is fragile and can be broken with the slightest tug on the driveline.  Driveline tugs sometimes occur.  I have been fortunate that no significant tugs on the line have occurred. 

Although the site is maintained as sterile, a break in the seal of the skin at the wound site is a fact of life for an LVAD. The break in the seal, even a slight one, can lead to an infection.

 As you may know from earlier posts, the driveline is another name for the percutaneous lead that carries power to the LVAD.           Percutaneous means through the skin.  Thoratec, maker of the HeartMate II LVAD, is developing a device that will be fully implantable with no external driveline.  It follows that with no wound site there would be no infection issue.

A Thoratec engineer talking about research and development said that a fully implantable LVAD with power system is some years away, five at a minimum.  The batteries that I carry will be miniaturized, implanted with the LVAD pump unit, and will be recharged using an external system.  The combination of miniaturization and external charging, will allow an LVAD to be fully immersible.  

Being waterproof would be a great improvement over the system I use, which must be protected from rain, bathing, showering, swimming, wading, boating, fishing and the host of other wet activities.

But that is in the future.  For now, LVADs' lives are maintained with the electrical system as it exists.  The potential for tugs and movement of the driveline is always present.  Either of those driveline movements could create the conditions that cause an infection. 

A friend's driveline site became so infected that he needed inter venous antibiotics and was hospitalized. The break in the seal of his drive line site was an unforeseen consequence of taking a shower.  His water resistant shower bag, in which LVADs secure their electronic system controller and two batteries, fell off its hook and yanked on his driveline. He had used the shower bag and hook for years with no negative consequences.

Now, he must take oral antibiotics until he receives a heart transplant or until his LVAD is replaced.  The problem is that just because the infection is controlled at the driveline exit site, that doesn't mean that the infection is resolved.  

The infection can migrate along the driveline to the heart. It is possible for the infection could "seed" the pump itself. Since the pump has no blood circulation of its own, the infection could last on the pump even if the driveline site is clear of infection.  That is a dangerous situation, potentially fatal.  Hopefully, long term antibiotics can keep the infection at bay.  No guarantees.

In LVAD living as in life for everyone, there are no guarantees, there are no assurances, there are no promises.  I am fortunate to be among the few of hundreds of thousands of congestive heart failure sufferers with an LVAD.  Not many can say they have another chance at life.  

My LVAD lifeat9200rpms: Oz, the Tin Man, and a new heart

Going to 1-A status on the UNOS transplant list gives me the willies.  As of Friday evening, July 20, 2012, the pre-transplant coordinator at the U of Minnesota confirmed that I'm now in 1-A status for the next 30 days.  I am using the term "the willies" as a substitute for saying I'm terrified.  

The words to the popular song that Oz never gave nothin' to the Tin Man that he didn't already have are very stubborn right now.  The lyrics and tune are running around in my head.  Thanks America.  

I've gotten this far, 27 months and 19 days downrange from my LVAD implant surgery, and I would not be here without old pump Number 8358 HeartMate II.  Do I really want to give up something that has given me back my life?  Or do I want to exercise the option of going through with a heart transplant?

If, successful, the transplant requires a completely new regimen of anti-rejection drugs for life.  I know there will be side effects from the drug therapy and those are not pleasant to contemplate.

So what makes a person like me, your ordinary 68 year old with a perfectly good heart pump, want to go for a transplant?  I've been asking myself that from day one on the transplant list.  The only answer I have is that I want to be around for as long as possible to interact with and to help my family:  partner, daughters, son, their families and our grandchild. 

The U surgeons transplanted two hearts Friday.  Is that a good omen?  It is good for the recipients but as I understand the situation it doesn't mean anything to my 1-A status.  If a matching donor heart is found, I'm told I get a call.

There are hiccups in the process.  The call comes to the 1-A person when UNOS's computers and statisticians declare a match for transplant.  At the same time a heart transplant team is dispatched to obtain the donated heart, assess it in person, and return with it to the U of MN hospital in Minneapolis.  The 1-A beats feet for the hospital.  Since I live in Fargo, 240 miles from Minneapolis, the air ambulance service is pre-arranged as my transport mode. It will be me my LVAD equipment and my wife.

Because the transplant isn't a go until the heart transplant recovery team obtains the donated heart and I am prepped for surgery, the operation could be scrubbed at any time until the heart surgeon begins opening my chest.  When a transplant operation is scrubbed, it gets chalked up to experience as a dry run.

Having been in the military, I accept the notion of "hurry up and wait."