Infectious complications following contemporary left ventricular assist device implantation

Abstract

Background: The aim of this study is to evaluate the source of infectious complications following contemporary left ventricular assist device (LVAD) implantation and to determine the impact of infections on patient outcomes.Methods: All patients who underwent centrifugal LVAD implantation between 2014 and 2020 at a single center were retrospectively reviewed. Postimplant infections were categorized as VAD-specific, VAD-related, or non-VAD according to previously published definitions. Postoperative survival and freedom from readmission were assessed using Kaplan-Meier analysis. Univariable and multivariable analyses were performed to determine the risk factors for postoperative infectious complications.Results: A total of 212 patients underwent centrifugal LVAD implantation (70 HeartMate 3, 142 HeartWare HVAD) during the study period. One hundred and two patients (48.1%) developed an infection, including 34 VAD-specific, 11 VAD-related, and 57 non-VAD. Staphylococcus species were the most common source of postoperative infection (n = 57, 33.7%). In multivariable analysis, diabetes significantly impacted overall postoperative infection rate. At 12 and 24 months, respectively, Kaplan-Meier survival was 81.1% and 61.6% in the infection group and 83.4% and 78.1% in the noninfection group (p = 0.006). Within the total cohort, 12-and 24-month freedom from infection were 46.2% and 31.9%, respectively. Patients with infectious complication had significantly lower rate of transplantation (16.4% vs. 43.6%; p < 0.001), increased overall mortality (46.3% vs. 17.3%, p < 0.001), and increased rates of noncardiac readmission (58.2% vs. 37.3%, p = 0.007). Conclusions: Infections are common following contemporary LVAD implantation and are most commonly non-VAD related. Patients with postoperative infectious complications have significantly reduced rates of transplantation, survival, and freedom from noncardiac readmission.

Infections in LVAD patients

“…An association between infection and device complications such as thrombosis, embolism, or bleeding has also been suggested 11,12 . However, this study found no such correlation between the two, with the cause of mortality being similar for the infected and noninfected patients 10 . In addition, the elements that make a candidate ineligible for transplant may be similar to risk factors that ultimately lead to infection.…”

“…11,12 However, this study found no such correlation between the two, with the cause of mortality being similar for the infected and noninfected patients. 10 In addition, the elements that make a candidate ineligible for transplant may be similar to risk factors that ultimately lead to infection. [Correction added on 24 May 2022, after first publication: The article type was revised from "Commentary" to "Invited Commentary".]…”

“…10 Understanding the etiology and timeline of infections after LVAD implantation is critical for the implementation of effective strategies towards infection prevention and performing an appropriate selection of recipients. 17,18 While previous studies have focused on LVAD specific infections, 7,13,14 Zhu et al 10 included both LVAD-related and non-LVAD infections. Thus, we believe this study will contribute to the existing literature discussing VAD candidacy selection, prevention, and treatment of device related and non-device related infections.…”

Infections in LVAD patients

“…In addition to pump and driveline infections, cardiac assist device patients are susceptible to a similar profile of postoperative infections as heart transplant or complex cardiac surgery patients 7,9 . This retrospective single‐center study analyzing 212 patients after LVAD implantation found that 48.1% of patients would develop a postoperative infection, with more than half (57.7%) of these infections being unrelated to the LVAD 10 . Infections deemed unrelated to the device occurred predominantly in the first 3 months following implantation 10 .…”

“…Previous studies have demonstrated that even in an uncomplicated postoperative course, it can take about 6 weeks for the inflammatory response and complement activation to normalize 16 . In the meantime, efforts towards early postoperative interventions such as minimizing time on the ventilator and early removal of indwelling urinary and central venous catheters should be incentivized to further reduce a patient's risk of infectious related complications 10 …”