Left ventricular assist device-related infections: a multicentric study

Siméon, S.; Flécher, Erwan; Revest, Matthieu; Niculescu, M; Roussel, J.C.; Michel, Magali; Leprince, Pascal; Tattevin, Pierre

doi:10.1016/j.cmi.2017.03.008

Cited by 51 publications

(37 citation statements)

References 15 publications

(11 reference statements)

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“…Only postoperative RVF occurring during the index hospitalization following LVAD implantation was considered. Device infection is per criteria established by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) [11]. Briefly, cutaneous site infections are defined as pain, erythema or purulent drainage at the driveline site with positive skin cultures.…”

Section: Methodsmentioning

confidence: 99%

Right ventricular failure following left ventricular assist device implantation is associated with a preoperative pro-inflammatory response

Tang

Haft

Romano

et al. 2019

J Cardiothorac Surg

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Background Systemic inflammation during implant of a durable left ventricular assist device (LVAD) may contribute to adverse outcomes. We investigated the association of the preoperative inflammatory markers with subsequent right ventricular failure (RVF). Materials and methods Prospective data was collected on 489 patients from 2003 through 2017 who underwent implantation of a durable LVAD. Uni- and multivariable correlation with leukocytosis was determined using linear and binary logistic regression. The population was also separated into low (< 10.5 K/ul, n = 362) and high ( > 10.5 K/ul, n = 127) white blood cell count (WBC) groups. Mantel-Cox statistics was used to analyze survival data. Results Postop RVF was associated with a higher preop WBC (11.3 + 5.7 vs 8.7 + 3.1) and C-reactive protein (CRP, 5.6 + 4.4 vs 3.3 + 4.7) levels. Multivariable analysis identified an independent association between increased WBC preoperatively with increased lactate dehydrogenase (LDH, P < 0.001), heart rate ( P < 0.001), CRP ( P = 0.006), creatinine ( P = 0.048), and INR ( P = 0.049). The high WBC group was more likely to be on preoperative temporary circulatory support (17.3% vs 6.4%, P < 0.001) with a trend towards greater use of an intra-aortic balloon pump (55.9% vs 47.2%, P = 0.093). The high WBC group had poorer mid-term survival ( P = 0.042). Conclusions Postop RVF is associated with a preoperative pro-inflammatory environment. This may be secondary to the increased systemic stress of decompensated heart failure. Systemic inflammation in the decompensated heart failure may contribute to RVF after LVAD implant.

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Section: Methodsmentioning

confidence: 99%

Right ventricular failure following left ventricular assist device implantation is associated with a preoperative pro-inflammatory response

Tang

Haft

Romano

et al. 2019

J Cardiothorac Surg

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“…A large prospective multicenter trial of 86 HeartMate II recipients identified depression and CKD as independent risk factors for infection [31], with adjusted hazard ratios of 2.8 (p = 0.007) and 1.7 (p = 0.023) respectively. A multicenter trial in France looked at 159 patients who received LVADs between 2007 and 2012 and found that 22.6% of the patients had at least one infectious complication [29]. LVAD infections in this cohort were associated with alcoholism in 33%, diabetes in 11% and other immunosuppression in 11%.…”

Section: Epidemiology and Risk Factors For Lvad Infectionsmentioning

confidence: 97%

“…Subsequent innovations (axial to centrifugal flow) have not resulted in a reduction in infectious complications [7,8] with an actual increase in sepsis with the Heartware HVAD device compared to HeartMate II control [7]. Studies have looked at factors including age [22], gender [23], body habitus including both small patients [24] and obesity [25], trauma [26], duration of LVAD support [27] as well as presence of comorbid conditions such as diabetes [28][29][30], depression and chronic kidney disease (CKD) [31], alcoholism and immunosuppression [29], and malnutrition ( [32,33] and references therein). In a Japanese multicenter trial looking at 300 patients receiving HeartMate II between April 2013 and December 2016, patients older than 60 had similar overall survival and risk of driveline and pocket infections [22].…”

Section: Epidemiology and Risk Factors For Lvad Infectionsmentioning

confidence: 99%

Left Ventricular Assist Device Infections

Skalweit¹

2018

Advanced Concepts in Endocarditis

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Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplantation vs. transplant is necessary, combined with extended antimicrobial therapy.

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“…In one recent study, 22.6% of patients with LVAD implantation presented with infectious complications, among which almost a third were caused by P. aeruginosa (3). We present here the high-quality draft genome sequence of a P.…”

Section: Announcementmentioning

confidence: 99%