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Observational Study
. 2019 Aug:214:69-76.
doi: 10.1016/j.ahj.2019.04.021. Epub 2019 May 6.

Risk factors and prognostic impact of left ventricular assist device-associated infections

Pierre Tattevin  1 , Erwan Flécher  1 , Vincent Auffret  1 , Christophe Leclercq  1 , Stéphane Boulé  2 , André Vincentelli  2 , Camille Dambrin  3 , Clément Delmas  3 , Laurent Barandon  4 , Vincent Veniard  4 , Michel Kindo  5 , Thomas Cardi  5 , Philippe Gaudard  6 , Philippe Rouvière  6 , Thomas Sénage  7 , Nicolas Jacob  7 , Pascal Defaye  8 , Olivier Chavanon  8 , Constance Verdonk  9 , Marylou Para  9 , Edeline Pelcé  10 , Vlad Gariboldi  10 , Matteo Pozzi  11 , Daniel Grinberg  11 , Arnaud Savouré  12 , Pierre-Yves Litzler  12 , Gerard Babatasi  13 , Annette Belin  13 , Fabien Garnier  14 , Marie Bielefeld  14 , David Hamon  15 , Nicolas Lellouche  15 , Louis Bernard  16 , Thierry Bourguignon  16 , Romain Eschalier  17 , Nicolas D'Ostrevy  17 , Jérôme Jouan  18 , Emilie Varlet  18 , Fabrice Vanhuyse  19 , Hugues Blangy  19 , Raphaël P Martins  1 , Vincent Galand  20
Affiliations
Free article
Observational Study

Risk factors and prognostic impact of left ventricular assist device-associated infections

Pierre Tattevin et al. Am Heart J. 2019 Aug.
Free article

Abstract

Background: Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections.

Methods: Patients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD-associated infection (driveline infection, pocket infection, or pump/cannula infection) during follow-up.

Results: Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infections diagnosed 6.5 months after implantation, including 171 (26.2%), 51 (7.8%), and 26 (4.0%) percutaneous driveline infection, pocket infection, or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%) or HeartWare (13.4%). Most patients (62%) had implantable cardioverter-defibrillators (ICDs) before LVAD, and 104 (16.0%) had ICD implantation, extraction, or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113' 45.4%), Enterobacteriaceae (n = 61; 24.6%), Pseudomonas aeruginosa (n = 34; 13.7%), coagulase-negative staphylococci (n = 13; 5.2%), and Candida species (n = 13; 5.2%). In multivariable analysis, HeartMate II (subhazard ratio, 1.56; 95% CI, 1.03 to 2.36; P = .031) and ICD-related procedures post-LVAD (subhazard ratio, 1.43; 95% CI, 1.03-1.98; P = .031) were significantly associated with LVAD infections. Infections had no detrimental impact on survival.

Conclusions: Left ventricular assist device-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and gram-negative bacilli, with increased risk with HeartMate II as compared with HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.

Trial registration: ClinicalTrials.gov NCT02873169.

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