Management and Outcome of Left Ventricular Assist Device Infections in Patients Undergoing Cardiac Transplantation

Abstract

Background: Postoperative management of patients undergoing cardiac transplantation with an infected left ventricular assist device (LVAD) is unclear.

Methods: We retrospectively screened all adults with an LVAD who underwent cardiac transplantation at our institution from 2010 through 2018. We selected all cases of LVAD-specific and LVAD-related infections who were receiving antimicrobial therapy as initial treatment course or chronic suppression at the time of cardiac transplantation. Non-LVAD infections, superficial driveline-infection, or concurrent use of right ventricular assist device or extracorporeal membrane oxygenation device were excluded.

Results: A total of 54 cases met study criteria with 18 of 54 (33.6%) classified as LVAD- specific or related infections and 36 of 54 (66.6%) as noninfected. cases of lvad infection had a higher median charlson comorbidity Index score at the time of transplantation compared with noninfected cases (P = .005). Of the 18 cases of infection, 13 of 18 (72.2%) were classified as LVAD-specific and 5 of 18 (27.8%) were classified as LVAD-related. Nine of 13 (69.2%) cases had proven LVAD-specific infections. Antimicrobial therapy was extended posttransplant to treat preceding LVAD-specific infection in all 9 cases (9 of 13, 69.2%) with a median duration of 14 days (interquartile range, 14-28). After LVAD removal, antimicrobial treatment was not continued for preceding LVAD-related infections.

Conclusions: Patients with an LVAD-specific infection were treated with 2 weeks of pathogen-directed therapy postheart transplant without any relapses. For those without LVAD-specific infection or uncomplicated LVAD-related bacteremia who had completed antimicrobial therapy pretransplant, antibiotics were discontinued after standard perioperative prophylaxis and no relapses were observed.

Keywords: heart transplant; left ventricular device infections; management; outcomes.

Figure 1.

Patient flow diagram. CF, continuous flow; ECMO, extracorporeal membrane oxygenation device; LVAD, left ventricular assist device; RVAD, right ventricular assist device;

Figure 2.

Kaplan-Meier survival analysis between left ventricular assist device (LVAD) infected and noninfected LVAD cases.

Figure 3.

Management of suspected left ventricular assist device (LVAD) infection at the time of heart transplant. *, Longer if complications such as mediastinitis or need for further debridement. **, Duration of routine perioperative prophylaxis at our institution is 48 hours posttransplant. ^aIf bloodstream infection (BSI) with fungal or mycobacterial organisms, consult Infectious Diseases (ID). abx, antibiotic; tx, transplant.