Relation of Left Ventricular Assist Device Infections With Cardiac Transplant Outcomes

Am J Cardiol. 2021 Dec 1:160:67-74. doi: 10.1016/j.amjcard.2021.08.044. Epub 2021 Oct 3.

Abstract

Left ventricular assist device (LVAD)-specific infections (LSIs) are common in patients on LVAD support awaiting heart transplant (HT), yet their impact on post-HT outcomes is not completely understood. We hypothesized that LSIs would result in vasoplegia and negatively affect post-HT 30-day and 1-year outcomes. LSI was defined as driveline, pump, or pocket infection. The short-term outcome was a composite of acute renal failure, allograft rejection, and mortality at 30 days after HT. The long-term outcome was a composite of allograft rejection and death within 1 year after HT. We performed a retrospective analysis of 111 HT recipients bridged with durable LVAD support at our institution from May 2012 to August 2019. Of these, 63 patients had LSIs, with 94% of the infections being driveline infections. Vasoplegia was more prevalent in the LSI group but not significantly (7 vs 2 persons, p = 0.3). There was no difference in the composite end point of acute renal failure, rejection, or death at 30 days (30% vs 25%, p = 0.55) or 1-year end point of rejection and death (38% vs 40%, p = 0.87) in patients with LSI versus those without LSI. In conclusion, LSIs were common in patients on LVAD who underwent HT in our single-center contemporary cohort. However, LSI was not associated with adverse outcomes at 30 days or at 1 year after HT.

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Aged
  • Cohort Studies
  • Female
  • Graft Rejection / epidemiology*
  • Heart Failure / therapy*
  • Heart Transplantation*
  • Heart-Assist Devices*
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • Postoperative Complications / epidemiology*
  • Preoperative Period
  • Prognosis
  • Prosthesis-Related Infections / epidemiology*
  • Retrospective Studies
  • Vasoplegia / epidemiology*