Cutaneous complications to medical adhesives in left ventricular assist device patients: A retrospective cohort study

Cutaneous complications to medical adhesives in left ventricular assist device patients: A retrospective cohort studyTo the Editor: Left ventricular assist devices (LVADs) support advanced patients with heart failure as a bridge to transplantation or as a long-term solution for patients that are ineligible for a transplant.Managing LVAD patients involves securing the driveline and using occlusive dressings for wound care, typically changed weekly or more frequently posttransplant and in the setting of complications. 1 Reports of allergic contact dermatitis (ACD) from wound dressings are increasing, yet data on ACD in LVAD patients remain limited.Therefore, we conducted a retrospective cohort study at our highvolume LVAD center to explore ACD incidence and associated cutaneous complications in LVADsupported patients.We reviewed charts of patients with heart failure with LVADs implanted between January 1, 2015, and June 1, 2023, who had the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code L23 for ACD.Data from Electronic Health Records included demographics, heart failure history, LVAD details, Fitzpatrick Skin Type, ACD diagnosis, dermatology involvement, and treatment.Patients with ACD unrelated to their LVAD were excluded.In total, 37 patient charts were included in our analysis.The majority were male (76%) with a mean age of 57.1 years.Most patients were Black or African American (86%) with nonischemic cardiomyopathy (92%), primarily treated with HeartMate 3 LVAD (87%).ACD at LVAD drive-line site occurred within 1 year of LVAD implantation in 57% of cases, with 57% of ACD diagnoses linked to concurrent infections.Consultations from dermatology services were received by 62% of ACD-diagnosed patients, averaging 2 follow-up appointments.Although ACD from medical adhesives was documented in approximately 8% of our LVAD patients, adhesives are a common but not exclusive source. 2 Our figures (Fig 1, A andB) included cases linked to both adhesives and other antiseptic substances, underscoring the complexity of identifying causative agents without patch testing.Patch testing confirmed sensitivity to ethyl cyanoacrylate in adhesives and