In Full Flow: Left Ventricular Assist Device Infections in the Modern Era

Zinoviev, Radoslav; Lippincott, Christopher K.; Keller, Sara C.; Gilotra, Nisha A.

doi:10.1093/ofid/ofaa124

Cited by 42 publications

(86 citation statements)

References 75 publications

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“…The literature mentions up to 51.9% infections after implantation of continuous-flow LVADs [24]. A recent review mentions 19-39% infection rates after implantation of second-and third-generation LVADs [25]. A Swiss group recently reported 45% LVAD-related infection after HeartMate 3 implantation, including driveline ex-site infections [26].…”

Section: Major Adverse Eventsmentioning

confidence: 99%

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

Schaeffer

Pfister

Mork

et al. 2021

J Cardiothorac Surg

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Background In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel. Methods We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data. Results Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively. Conclusions The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial. Trial registration This study was registered on the ClinicalTrials.gov database (NCT04263012).

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Section: Major Adverse Eventsmentioning

confidence: 99%

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

Schaeffer

Pfister

Mork

et al. 2021

J Cardiothorac Surg

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“…In additionally, previous studies about old generation pumps reported that the pump pocket site is a poorly vascularized space. 21 Hematoma or seroma formation in the large subcutaneous space created in this procedure may also lead to compromised wound healing and subsequent infection. 20 All these factors delay wound healing and cause infection in the driveline tunnel between thoracotomy incision and driveline exit site.…”

Section: Discussionmentioning

confidence: 99%

Does minimally invasive approach reduce risk of infection after ventricular assist device implantation?

et al. 2021

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Background: We analyzed patients with left ventricular assist device (LVAD) related and specific infection, and aimed to determine whether surgical technique implantation affect the frequency of infection. Methods: We retrospectively analyzed the data of 99 patients who received LVAD at our department between June 2013 and June 2019. Patients were divided into two groups according to the surgical technique. Group A ( n = 58) was conventional sternotomy (CS) and group B ( n = 41) was on-pump minimally invasive left thoracotomy (MILT). Demographics, preoperative risk factors, LVAD infections, surgical incision site, driveline site, and outcomes were compared between these two groups. Results: Mean follow up time was 589 ± 480 (31–2171) days. Infection was detected in 34% (41/99) of LVAD patients. Admission to emergency department and intensive care unit (ICU) in last 6 months were significantly higher in MILT group. There was no difference between the two groups in terms of driveline exit site infection (CS: 28%, MILT: 27%) ( p > 0.05). Seven (17%) patients had infection in the thoracotomy incision site area in the MILT group. The rate of ICU hospitalization in the last 6 months was seen as the only independent risk factor increasing the frequency of infection (R = 0.30; p = 0.016). Survival analysis at 60 days, 1 year and 2 years showed no difference between the two groups ( p = 0.09). Conclusions: Despite advances in pump technology and surgical technique, infection is still an important cause of mortality and morbidity.

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“…13 Practice patterns are variable with many institutions continuing to use suppression routinely for superficial DLI. 14,15 In our institution, there was a change in the practice pattern in the latter part of the study period (2013)(2014)(2015), during which 81% of patients were placed on CSA compared with only 48% in the earlier study period. with resolution of all symptoms and signs of infection.…”

Section: F I G U R E 1 Kaplan-meier Curve For Infection Recurrence Among Those Who Received Suppression and Those Who Did Notmentioning

confidence: 96%

“…13 However, many centers still opt to place patients on chronic suppressive antibiotics (CSA) therapy following clinical response with the goal to prevent relapse with the same organism. 14,15 Few studies tried to answer this question, but they were limited by small numbers. 10 We sought to examine risk factors for relapse of DLI, and whether CSA is associated with reduced risk of relapse and progression to deeper infection in this population.…”

Section: Introductionmentioning

confidence: 99%

The role of chronic suppressive antibiotics therapy in superficial drive line infection relapse of left ventricular assist devices: A retrospective cohort from a tertiary care center

Hamad

Blanco-Guzman

Olsen

et al. 2021

Transplant Infectious Dis

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Introduction: Drive line infections (DLIs) are common complications of left ventricular assist devices (LVADs). Data on use of suppression antibiotic therapy are limited. Methods:We performed a retrospective review of 451 patients who underwent LVAD placement from January 2009 to May 2015. First superficial DLIs were included for analysis. We examined factors associated with the use of chronic suppressive antibiotics (CSAs) therapy. Cox proportional hazards models were performed to identify factors associated with DLI relapse with the same organism as the initial DLI.Results: A total of 69 patients developed a superficial DLI within a median of 195 (interquartile range [IQR] 98-348) days of LVAD insertion. The median age was 57 years, 87% were males, and 74% were White. Gram positive bacteria caused 61% of infections, with Staphylococcus aureus being the most common (35%). Forty-three (62%) patients received suppressive antibiotic therapy. Relapse DLI occurred in 29 (42%) patients. Independent risk factors for relapse infection in multivariable analysis were sepsis (aHR 5.94 ), and MRSA DLI (aHR 4.19 ).There was no difference in the proportion of patients with relapse among those who were treated with antibiotic suppression therapy versus not (44% vs. 38%, p = 0.64), although relapse occurred at a later time in those who received suppression (185 vs. 69 days, p < 0.01). Conclusion:CSA therapy was associated with delayed time to DLI relapse but no significant difference in the proportion of patients with relapse. A prospective study is needed to examine the effect of suppression on relapse rates.

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In Full Flow: Left Ventricular Assist Device Infections in the Modern Era

Cited by 42 publications

References 75 publications

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

Does minimally invasive approach reduce risk of infection after ventricular assist device implantation?

The role of chronic suppressive antibiotics therapy in superficial drive line infection relapse of left ventricular assist devices: A retrospective cohort from a tertiary care center

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