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

Pierre Tattevin, Erwan Flécher, Vincent Auffret, Christophe Leclercq, Stéphane Boulé, André Vincentelli, Camille Dambrin, Clément Delmas, Laurent Barandon, Vincent Veniard, Michel Kindo, Thomas Cardi, Philippe Gaudard, Philippe Rouvière, Thomas Sénage, Nicolas Jacob, Pascal Defaye, Olivier Chavanon, Constance Verdonk, Marylou ParaEdeline Pelcé, Vlad Gariboldi, Matteo Pozzi, Daniel Grinberg, Arnaud Savouré, Pierre Yves Litzler, Gerard Babatasi, Annette Belin, Fabien Garnier, Marie Bielefeld, David Hamon, Nicolas Lellouche, Louis Bernard, Thierry Bourguignon, Romain Eschalier, Nicolas D'Ostrevy, Jérôme Jouan, Emilie Varlet, Fabrice Vanhuyse, Hugues Blangy, Raphaël P. Martins, Vincent Galand

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

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.

Original languageEnglish
Pages (from-to)69-76
Number of pages8
JournalAmerican Heart Journal
Volume214
DOIs
StatePublished - Aug 2019
Externally publishedYes

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