1107. Ventricular Assist Device (VAD) Related Infections Increase One-Year Mortality
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA_VAD.pdf (1.9 MB)
  • Background: While infection is a common complication of left ventricular assist devices (LVAD), the impact of LVAD related infection on mortality is unclear.  The goal of this study was to examine the incidence of LVAD related infections in the first year post-implantation and assess their effects on mortality.

    Methods: We evaluated a retrospective cohort of LVAD patients seen at the University of Alabama at Birmingham (UAB) during 2004-2009.  Data were collected regarding infection, underlying disease and outcome. Statistical analyses were performed to determine the association of VAD-related infections on patient outcomes and mortality.

    Results: 87 patients (68 males; mean age 52 years) underwent LVAD implantation with a HeartMate II (44%) or HeartMate XVE (36%). Of the 87 patients, 31 (36%) died, 21 (24%) were transplanted, and 3 (3%) were explanted; the remainder continue to receive LVAD support.  Median length of follow-up was 1.1 years (range 19 days to 5.2 years). Infection occurred in 56 (64%) patients, including 42 (75%) patients with bloodstream infection (BSI), 38 (68%) patients with driveline infection (DLI), and 13 (23%) with device/pump pocket infection.  The most common organisms causing infection were coagulase-negative staphylococci (50%), Methicillin-resistant Staphylococcus aureus (12%), and Methicillin-sensitive Staphylococcus aureus (11%).  The incidence of DLI at one year post-implant was 50%; 65% in the pulsatile device (PD) group and 39% in the continuous flow device (CFD) group (p=0.03).  The incidence of BSI at one year post-implant was 41%; 57% versus 29% in the PD and CFD groups, respectively (p < 0.01). Patients who developed either DLI or BSI in the first year post-implant had decreased one-year survival (87% vs. 75%, p=0.04 and 91% vs. 61%, p< 0.01, respectively), compared to those patients who had not.

    Conclusion: Infection is a frequent complication of VAD implantation and is usually caused by Staphylococcus species. Both DLI and BSI are associated with decreased one-year survival.  Strategies to prevent VAD-related infections, as well as further studies investigating risk factors for the development of VAD-related infection, might decrease mortality.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Tatiana Saavedra, MD1, Salpy Pamboukian, MD2, John Baddley, MD, MSPH1,3, Mukesh Patel, MD1, Jose Tallaj, MD2, Robert Brown, BS4, James F. George, Ph.D.5, William Holman, MD4 and James Kirklin, MD4, (1)Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, (2)Department of Cardiology, University of Alabama at Birmingham, Birmingham, AL, (3)Birmingham Veterans Affairs Medical Center, Birmingham, AL, (4)Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, (5)Cardiovascular/Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL

    Disclosures:

    T. Saavedra, None

    S. Pamboukian, Thoratec: Honoraria, Speaker honorarium and Travel and accomodation to Thoratec meeting

    J. Baddley, Pfizer: Consultant and Grant Investigator, Consulting fee
    Merck: Scientific Advisor, Consulting fee

    M. Patel, None

    J. Tallaj, None

    R. Brown, None

    J. F. George, None

    W. Holman, None

    J. Kirklin, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.