Risk factors and prognostic impact of left ventricular assist device-associated infections.
Am Heart J
; 214: 69-76, 2019 08.
Article
in En
| MEDLINE
| ID: mdl-31174053
ABSTRACT
BACKGROUND:
Left 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.METHODS:
Patients 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.RESULTS:
Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5â¯months 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 58.7â¯years, 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 (nâ¯=â¯113' 45.4%), Enterobacteriaceae (nâ¯=â¯61; 24.6%), Pseudomonas aeruginosa (nâ¯=â¯34; 13.7%), coagulase-negative staphylococci (nâ¯=â¯13; 5.2%), and Candida species (nâ¯=â¯13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; Pâ¯=â¯.031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; Pâ¯=â¯.031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival.CONCLUSIONS:
Left 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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart-Assist Devices
/
Prosthesis-Related Infections
/
Catheter-Related Infections
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Am Heart J
Year:
2019
Document type:
Article
Affiliation country: