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Meta-Analysis
. 2018 May/Jun;64(3):287-294.
doi: 10.1097/MAT.0000000000000684.

Left Ventricular Assist Device Infections: A Systematic Review

John C O'Horo  1   2 , Omar M Abu Saleh  1 , John M Stulak  3 , Mark P Wilhelm  1 , Larry M Baddour  1   4 , M Rizwan Sohail  1   4
Affiliations
Meta-Analysis

Left Ventricular Assist Device Infections: A Systematic Review

John C O'Horo et al. ASAIO J. 2018 May/Jun.

Abstract

Left ventricular assist devices (LVADs) are becoming a more frequent life-support intervention. Gaining an understanding of risk factors for infection and management strategies is important for treating these patients. We conducted a systematic review and meta-analysis of studies describing infections in continuous-flow LVADs. We evaluated incidence, risk factors, associated microorganisms, and outcomes by type of device and patient characteristics. Our search identified 90 distinct studies that reported LVAD infections and outcomes. Younger age and higher body mass index were associated with higher rates of LVAD infections. Driveline infections were the most common infection reported and the easiest to treat with fewest long-term consequences. Bloodstream infections were not reported as often, but they were associated with stroke and mortality. Treatment strategies varied and did not show a consistent best approach. LVAD infections are a significant cause of morbidity and mortality in LVAD patients. Most research comes from secondary analyses of other LVAD studies. The lack of infection-oriented research leaves several areas understudied. In particular, bloodstream infections in this population merit further research. Providers need more research studies to make evidence-based decisions about the prevention and treatment of LVAD infections.

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Conflict of interest statement

Conflict of Interest and Funding Sources

Dr. Sohail reports receiving funds from TYRX Inc. and Medtronic for prior research unrelated to this study and honoraria/consulting fees from Medtronic, Spectranetics, and Boston Scientific. Dr. Baddour receives financial support unrelated to this research from UpToDate royalties and the Massachusetts Medical Society for his duties as Editor-in-Chief of NEJM Journal Watch Infectious Diseases.

This project was supported in part by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This publication was also made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Figures

Figure 1
Figure 1
PRISMA study selection flow diagram.
Figure 2
Figure 2
Forest plot of infection rates for the HeartMate II compared with the HeartWare HVAD: data from Haglund et al (all types of infections, including driveline, sternal wound, and non-LVAD infections); Majure et al (rehospitalizations due to LVAD infections); and Sabashnikov et al (percutaneous site infections treated only with antimicrobial agents); and the Evaheart: data from Matsumoto et al (freedom-from-exit-site infection at 1 year [major endpoint], presented as number of patients with at least 1 exit-site infection in 1 year). Pooled estimates were not significant, likely because of the high degree of heterogeneity in the studies.
Figure 3
Figure 3
Studies reporting an association between mortality by infection type
See this image and copyright information in PMC

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