Stroke and death risk in ventricular assist device patients varies by ISHLT infection category: An INTERMACS analysis

Shah, Palak; Birk, Sarah; Cooper, Lauren B.; Psotka, Mitchell A.; Kirklin, James K.; Barnett, Scott D.; Katugaha, Shalika B.; Phillips, Sheila; Looby, Mary; Pagani, Francis D.; Cowger, Jennifer

doi:10.1016/j.healun.2019.02.006

Cited by 38 publications

(31 citation statements)

References 28 publications

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“…10 Shah et al reported the survival of VAD patients during the 2-year follow-up after VAD implantation who developed any type of infection was 59% compared with 74.8% in patients without infection. 11 Survival of VAD patients with VAD-specific infection was 87% at 1 year as compared with VAD-related (71%) and non-VAD infections (72%, p < 0.001) (►Fig. 3.).…”

Section: Epidemiology Of Vad Infectionsmentioning

confidence: 94%

“…3.). 11 It is an important finding that is particularly germane to VAD patients that in the presence of infection these patients are at increased risk for a stroke. The study by Shah et al 11 demonstrated a higher stroke prevalence in comparison with patients without an infection (18% vs. 11%, p < 0.001).…”

Section: Epidemiology Of Vad Infectionsmentioning

confidence: 99%

“…30,31 Furthermore, it has been reported that microorganisms adhere on both smooth and velour section of the driveline and ascend into the subcutaneous driveline tunnel which is Fig. 4 Cumulative incidence of stroke after ventricular assist device (VAD) implantation according to Shah et al 11 Note the differences in time to first stroke between three infection groups (VAD-related, VADspecific, and non-VAD) and no infection group (reprinted with permission). 11 Fig.…”

Section: Pathophysiology Of Vad-specific Infectionmentioning

confidence: 99%

“…4 Cumulative incidence of stroke after ventricular assist device (VAD) implantation according to Shah et al 11 Note the differences in time to first stroke between three infection groups (VAD-related, VADspecific, and non-VAD) and no infection group (reprinted with permission). 11 Fig. 2 Freedom from the combined major event of first infection, bleeding, device malfunction, stroke, or death (reprinted with permission).…”

Section: Pathophysiology Of Vad-specific Infectionmentioning

confidence: 99%

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Ventricular Assist Device Driveline Infections: A Systematic Review

Krželj

Petričević

Gašparović

et al. 2021

Thorac Cardiovasc Surg

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Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients.

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Section: Epidemiology Of Vad Infectionsmentioning

confidence: 94%

Section: Epidemiology Of Vad Infectionsmentioning

confidence: 99%

Section: Pathophysiology Of Vad-specific Infectionmentioning

confidence: 99%

Section: Pathophysiology Of Vad-specific Infectionmentioning

confidence: 99%

See 2 more Smart Citations

Ventricular Assist Device Driveline Infections: A Systematic Review

Krželj

Petričević

Gašparović

et al. 2021

Thorac Cardiovasc Surg

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“…23,24 The lack of a relationship between pre-surgical stroke and post-surgical stroke and death may be related to a tendency to exclude patients with major stroke from LVAD candidacy as well as the careful medical management that typically follows LVAD placement (including anticoagulation), possibly mitigating stroke risk factors. 31 We did not find an association between post-LVAD infection and stroke, although this had been reported previously, 32 likely due to a substantial difference in sample size and our decision to limit the definition of LVAD-related infection to involvement of the driveline only.…”

Section: Discussionmentioning

confidence: 54%

Predicting post-LVAD outcome: Is there a role for cognition?

et al. 2020

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Background: Cognition has been found to influence risk of stroke and death for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implant. We aimed to study the relationship between cognition, stroke, and death in a cohort of patients who received LVAD therapy. It was hypothesized that cognitive test results obtained prior to LVAD placement would predict stroke and death after surgery. Methods: We retrospectively identified 59 HF patients who had cognitive assessment prior to LVAD placement. Cognitive assessment included measures of attention, memory, language, and visualmotor speed and were averaged to produce one z-score variable per patient. Survival analyses, censored for transplant, evaluated predictors for stroke and death within a follow-up period of 900 days. Results: For patients with stroke or death during the follow up period, the average cognitive z-score predicted post-LVAD stroke (HR = 0.513, 95% CI = 0.31–0.86, p = 0.012) and death (HR = 0.166, 95% CI = 0.06–0.47, p = 0.001). Cognitive performances were worse in the patients who suffered stroke or died. No other variable predicted stroke and death within the follow up period when the cognitive variable was in the model. Conclusion: Cognitive performance was predictive of post-LVAD risk of stroke and death. Results are consistent with findings from other studies in non-LVAD samples and may reflect early signs of neurologic vulnerability. Further studies are needed to clarify the relationship between cognition and LVAD outcomes in order to optimize patient selection, management, and advanced care planning.

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