1251. Determinants of Infection at a Nontransplanting Cardiothoracic LVAD Program

Abstract

BackgroundLeft ventricular assist devices (LVADs) are a treatment option for end-stage heart failure, traditionally used as a bridge to a transplant. However, LVADs as a destination therapy is an option for individuals with contraindications for transplant. Infections are a common and devastating complication with significant morbidity and mortality. The purpose of this study was to assess the impact of risk factors for LVAD-associated infections in a nontransplant LVAD center.MethodsAll patients with implanted LVADs from 2013–2018 at Prisma Health were screened for inclusion. LVAD-associated infection was defined using INTERMACS criteria. Patient characteristics and device characteristics were evaluated for infection risk. Time to infection and associated mortality were also analyzed.ResultsFifty-four of 138 (39.1%) patients developed an LVAD infection (driveline infection, or bacteremia). Mean time to infection among those who experienced infections was 7.78 months, with a standard deviation of 9.58 months. Table 1 summarizes baseline patient characteristics. HeartWare devices, compared with HeartMate II, were at an increased risk of infections and had a shorter time to infection (Figure 1) (HeartWare vs. HeartMate II, HR 2.12, P = 0.01). Those with a BMI of ≥35 kg/m2 were found on average to have a number of infections 0.729 greater than those with a BMI < 35 kg/m2 (P = 0.01). Prealbumin, A1C, and chronic kidney disease (any stage) were not found to be associated with infection. Staphylococcus aureus (21, 18.26%), Pseudomonas aeruginosa (24, 20.87%), and Staphylococcus epidermidis (22, 19.13%) were the most common organisms identified.ConclusionIn an LVAD center where the majority of patients received LVAD as destination therapy, infection rates were similar as those receiving LVAD as a bridge to transplant. Modifiable risk factors for infection are areas for future interventions and prevention efforts. Disclosures All authors: No reported disclosures.