Pierre Tattevin1, Erwan Flécher1, Vincent Auffret1, Christophe Leclercq1, Stéphane Boulé2, André Vincentelli2, Camille Dambrin3, Clément Delmas3, Laurent Barandon4, Vincent Veniard4, Michel Kindo5, Thomas Cardi5, Philippe Gaudard6, Philippe Rouvière6, Thomas Sénage7, Nicolas Jacob7, Pascal Defaye8, Olivier Chavanon8, Constance Verdonk9, Marylou Para9, Edeline Pelcé10, Vlad Gariboldi10, Matteo Pozzi11, Daniel Grinberg11, Arnaud Savouré12, Pierre-Yves Litzler12, Gerard Babatasi13, Annette Belin13, Fabien Garnier14, Marie Bielefeld14, David Hamon15, Nicolas Lellouche15, Louis Bernard16, Thierry Bourguignon16, Romain Eschalier17, Nicolas D'Ostrevy17, Jérôme Jouan18, Emilie Varlet18, Fabrice Vanhuyse19, Hugues Blangy19, Raphaël P Martins1, Vincent Galand20. 1. Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France. 2. CHU Lille, Institut Coeur-Poumons, Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Lille, France. 3. Centre Hospitalier Universitaire de Toulouse, Toulouse, France. 4. Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France. 5. Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France. 6. Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France. 7. Department of Cardiology and Heart Transplantation Unit, CHU, Nantes, France. 8. Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France. 9. Department of Cardiology and cardiac surgery, Bichat-Hospital, Paris, France. 10. Department of Cardiac Surgery, La Timone Hospital, Marseille, France. 11. Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France. 12. Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France. 13. Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France. 14. Department of Cardiology and cardiac surgery, University Hospital, Dijon, France. 15. Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France. 16. Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France. 17. CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France. 18. Cardiology Department, European Georges Pompidou Hospital, Paris, France. 19. Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France. 20. Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France. Electronic address: vincent.galand35@gmail.com.
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.
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.
Authors: Heidi S Lumish; Barbara Cagliostro; Lorenzo Braghieri; Bruno Bohn; Giulio M Mondellini; Karen Antler; Vivian Feldman; Audrey Kleet; Jennifer Murphy; Melie Tiburcio; Kathryn Fidlow; Douglas Jennings; Gabriel T Sayer; Koji Takeda; Yoshifumi Naka; Ryan T Demmer; Justin G Aaron; Nir Uriel; Paolo C Colombo; Melana Yuzefpolskaya Journal: ASAIO J Date: 2022-03-01 Impact factor: 3.826