植込み型補助人工心臓のドライブライン感染

Driveline Infection of Implantable Left Ventricular Assist Devices

現在日本では，成人における植込み型左室補助人工心臓（implantable left ventricular assist device：iLVAD）から心臓移植までの期間は長く，2022年にstatus 1（治療などの状況による優先度）での心移植までの待機期間が1,877日（約5.1年）と報告されている1）．さらに2021年に永久植込み治療（DT）が保険収載されたことから，今後iLVAD症例全体の平均留置期間がさらに長期化してくることが予想される．

In Japan, the median waiting period from implantable left ventricular assist device （iLVAD） implantation to heart transplantation is 5.1 years, with driveline infections occurring in approximately 20％ of cases within the first year. At our institution, we implemented the triple tunnel method and a structured care protocol to mitigate infection risk. This protocol includes meticulous monitoring, the use of sterilized kits, chlorhexidine, and caregiver training. Among 25 patients, driveline infections occurred in 12％ （three cases）, but none progressed to pump infections. Kaplan-Meier analysis showed infection-free rates of 100％ at one year and 85％ at three years, slightly surpassing national benchmarks. These outcomes highlight the importance of early detection, multidisciplinary follow-up, and consistent care in ensuring successful long-term management of iLVAD patients.