American heart journal | 2019
Risk factors and prognostic impact of left ventricular assist device-associated infections.
Abstract
BACKGROUND\nLeft ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections.\n\n\nMETHODS\nPatients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD-associated infection (driveline infection, pocket infection, or pump/cannula infection) during follow-up.\n\n\nRESULTS\nOf the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5\u202fmonths after implantation, including 171 (26.2%), 51 (7.8%), and 26 (4.0%) percutaneous driveline infection, pocket infection, or pump/cannula infection, respectively. Patients with infections were aged 58.7\u202fyears, and most received HeartMate II (82.1%) or HeartWare (13.4%). Most patients (62%) had implantable cardioverter-defibrillators (ICDs) before LVAD, and 104 (16.0%) had ICD implantation, extraction, or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n\u202f=\u202f113 45.4%), Enterobacteriaceae (n\u202f=\u202f61; 24.6%), Pseudomonas aeruginosa (n\u202f=\u202f34; 13.7%), coagulase-negative staphylococci (n\u202f=\u202f13; 5.2%), and Candida species (n\u202f=\u202f13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; P\u202f=\u202f.031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; P\u202f=\u202f.031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival.\n\n\nCONCLUSIONS\nLeft ventricular assist device-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and gram-negative bacilli, with increased risk with HeartMate II as compared with HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.