Elsevier

The Annals of Thoracic Surgery

Volume 94, Issue 5, November 2012, Pages 1387-1393
The Annals of Thoracic Surgery

Original article
Adult cardiac
Risk Analysis of Bloodstream Infection During Long-Term Left Ventricular Assist Device Support

Presented at the Fifty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 9–12, 2011.
https://doi.org/10.1016/j.athoracsur.2012.03.021Get rights and content

Background

Infection during left ventricular assist device (LVAD) support is associated with a high mortality. This study investigated the effect of bloodstream infection on survival of patients with LVAD support and assessed risk factors for survival in LVAD patients with bloodstream infection.

Methods

Between 1999 and 2010, 109 consecutive patients with end-stage heart failure were supported by an LVAD as a bridge to transplantation. Overall survival was compared between those with and without a bloodstream infection. Risk factors for survival of patients with bloodstream infection were analyzed.

Results

A bloodstream infection developed in 65 patients (60%) during 584 ± 389 days of LVAD support. Compared with patients without a bloodstream infection, overall survival was significantly worse in those with bloodstream infection (68% vs 84% at 2 years after LVAD implantation, p = 0.0117). However, of 22 patients bridged to transplantation, none had bloodstream infection recurrence after transplantation, and their 3-year survival rate after transplantation was 100%. Cox multivariate analysis (hazard ratio [95% confidence interval]) identified postoperative right ventricular failure (2.890 [1.238 to 6.757]; p = 0.0141) and bloodstream infection caused by a pathogen other than gram-positive cocci (3.336 [1.390 to 8.006] p = 0.0070) as significant risk factors for death in LVAD patients with a bloodstream infection.

Conclusions

Bloodstream infection had a significant effect on survival after LVAD implantation. Our results suggest that urgent cardiac transplantation should be considered for LVAD patients with a bloodstream infection based on the causative organism and right ventricular function.

Section snippets

Patients and Methods

The Institutional Ethics Committee of our institution approved this study, and written informed consent for the procedure was obtained from all patients before they underwent operations.

BSI in Patients With Long-Term LVAD Support

The mean duration of LVAD support was 584 ± 389 days (range, 17 to 1,703 days; median, 527 days). We identified 221 BSI events in 65 patients during LVAD support (Table 2), for a rate of 60% and incidence of 2.1 ± 6.5 BSI events per patient per 365 LVAD days. Among them, BSI was related to inflow or outflow cannula infections in 52, device endocarditis in 2, and indwelling central catheter infections in 11. BSI caused by a pacemaker infection developed in 1 patient who received steroid

Comment

Infection is a significant cause of morbidity and death in LVAD patients. Sepsis accounted for 41% of deaths in patients with a pulsatile HeartMate LVAD [12], and even in patients with the newer-generation HeartMate II LVAD, sepsis accounted for 20% of deaths at 6 months after implantation [13]. Because BSI is regarded as an important sign of sepsis [14], LVAD patients with active BSI are upgraded to United Network for Organ Sharing (UNOS) priority 1A for urgent heart transplantation [15, 16].

References (21)

There are more references available in the full text version of this article.

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