Background: Infection is a serious complication of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen for LVAD implantation is not well established. We compared risk of LVAD specific infections and all-cause mortality outcomes between SIP regimens at postoperative day 90 and one year using Kaplan-Meier time to event analysis.
Methods: We retrospectively reviewed 239 adults who underwent continuous-flow LVAD implantation from February 2007 to March 2015 at Mayo Clinic Rochester. LVAD infection (LVADI) was defined using criteria published by the International Society for Heart and Lung Transplant. Patients excluded from the analysis included those who did not have HeartMate II or HeartWare device, patients with incomplete documentation of SIP, and those with an actively treated infection at the time of LVAD implantation.
Results: LVADI occurred in 3 patients (1.5%) in the single drug group versus 2 (5.0%) in the multi-drug group at 90 days (p=0.4). There were no fungal LVADI, and gram negative (n=8) LVADIs were rare. There was no difference in infection-free survival between two groups at one year [(p=0.4), figure 1]. Moreover, no differences in overall survival between two SIP groups were observed [(p=0.9), figure 2].
Conclusion: Overall, there was no clear benefit of using multi drug regimen as it did not show difference in infection free survival or all-cause mortality compared to single drug regimen. Prospective clinical trials are needed to further define the optimal SIP regimen for LVAD implantation.
Figure 1: Infection-free survival in single vs. multi-drug SIP regimen at 1-year
Figure 2: Overall survival in single vs. multi-drug SIP regimen at 1-year
S. Farid, None
M. Berg, None
J. J. Nienaber, None
V. Tchantchaleishvili, None
J. Stulak, None
M. R. Sohail, None