Michael Z Tong1, Nicholas G Smedira2, Edward G Soltesz2, Randall C Starling3, Christine E Koval4, Liane Porepa3, Nader Moazami2. 1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: tongz@ccf.org. 2. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio. 3. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio. 4. Department of Infectious Disease, Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Abstract
BACKGROUND: Left ventricular assist device (LVAD) infections including drivelines, pump pockets, and bacteremia are difficult to manage and conservative treatments may not be effective as the infected foreign material remains. METHODS: We performed a retrospective analysis of all 170 HeartMate II (Thoratec, Pleasanton, CA) implantations as bridge to transplant (BTT) between 2004 and 2012 at our institution. Sixty-one patients (36%) developed a culture positive driveline infection, pump pocket infection, bacteremia, or a combination of these. Twenty-six out of 61 patients with an infection and 49 out of 109 patients without an infection went on to receive a heart transplant. RESULTS: The 1- and 3-year freedom from LVAD infection was 60% and 32%, respectively. While early infection tends to first present as driveline infections, late infections tend to present initially as bacteremia. The 1-year likelihood of receiving a transplant in the patients with an LVAD infection group was 37%, compared with 43% in patients without an infection (p = 0.36). One-year survival to transplantation was 76% in patients with LVAD infection compared with 81% without (p = 0.33). The 1- and 3-year posttransplant survival in patients with a LVAD infection was 96% and 91%, respectively, compared with 92% and 88% in patients without an infection (p = 0.48) . CONCLUSIONS: In this nonmatched cohort of LVAD patients with and without infection, selected patients with controlled LVAD infection have an equal chance of getting transplanted with excellent early and late post-transplant survival.
BACKGROUND: Left ventricular assist device (LVAD) infections including drivelines, pump pockets, and bacteremia are difficult to manage and conservative treatments may not be effective as the infected foreign material remains. METHODS: We performed a retrospective analysis of all 170 HeartMate II (Thoratec, Pleasanton, CA) implantations as bridge to transplant (BTT) between 2004 and 2012 at our institution. Sixty-one patients (36%) developed a culture positive driveline infection, pump pocket infection, bacteremia, or a combination of these. Twenty-six out of 61 patients with an infection and 49 out of 109 patients without an infection went on to receive a heart transplant. RESULTS: The 1- and 3-year freedom from LVAD infection was 60% and 32%, respectively. While early infection tends to first present as driveline infections, late infections tend to present initially as bacteremia. The 1-year likelihood of receiving a transplant in the patients with an LVAD infection group was 37%, compared with 43% in patients without an infection (p = 0.36). One-year survival to transplantation was 76% in patients with LVAD infection compared with 81% without (p = 0.33). The 1- and 3-year posttransplant survival in patients with a LVAD infection was 96% and 91%, respectively, compared with 92% and 88% in patients without an infection (p = 0.48) . CONCLUSIONS: In this nonmatched cohort of LVAD patients with and without infection, selected patients with controlled LVAD infection have an equal chance of getting transplanted with excellent early and late post-transplant survival.
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