In left ventricular assist device (LVAD) recipients, bloodstream infections (BSIs) are associated with significant morbidity and mortality, high rates of device seeding, and persistent bacteremia, often requiring urgent transplantation. In the present study, we sought to identify risk factors for development of BSIs and their impact on heart transplantation and mortality while on LVAD support.
Patients who underwent continuous flow (CF) LVAD implantation at our institution (1/2006 - 7/2016) were reviewed for BSIs. Logistic and Cox (with time-varying parameters) regression was used to identify predictors of BSI and investigate the impact on mortality and time-to-transplantation.
Of 212 patients who received LVADs (80% male, 58% with ischemic cardiomyopathy, 86% INTERMACS profile 1 3, 59% bridge to transplant, 80% HeartMate II), 58% experienced infections. Driveline infections (DLI) affected 31%; 19% had deep tissue involvement. Sixty-six patients (31%) developed 135 BSIs (incidence rate 8.65/10,000 person days on LVAD support), of which 52% were LVAD-specific and 39% were LVAD-related. Median time to first BSI was 108 (range 1 1965) days from implantation. Right heart failure, destination therapy, INTERMACS profile, morbid obesity and deep DLI were independent risk factors for BSI. BSI (time-dependent HR, 8.5; 95% CI, 5.0 14.4; P< 0.001) were independently associated with mortality (Figure 1), along with age, destination therapy, pump thrombosis, and stroke. Bridge to transplant patients were more likely to receive transplant if they did not have BSIs. Among 104 patients who received heart transplantation, BSI was associated with shorter time to transplantation (time-dependent HR, 2.0; 95% CI, 1.2 3.3; P=0.009).
In this single-center cohort, destination therapy, right heart failure, INTERMACS profile, morbid obesity, and deep DLI were independent predictors for BSI. BSIs are associated with increased mortality in CF LVAD recipients, despite the resultant upgrade in listing status and potentially shorter time-to-transplantation. BSIs should be regarded as a serious complication, similar to pump thrombosis and stroke.
Figure 1. Impact of BSI on survival in A) all, B) BTT-only, and C) DT-only CF LVAD recipients.
D. Farmakiotis, None
P. Mahale, None
E. Horn, None
S. Murali, None
R. Benza, None
S. Bailey, None
R. Agarwal, None