Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY, USA.
J Heart Lung Transplant. 2012 Nov;31(11):1151-7. doi: 10.1016/j.healun.2012.05.004. Epub 2012 Jul 4.
Although continuous-flow left ventricular assist device (LVAD) support has become standard therapy, the complexities of device and patient management remain a challenge. In particular, percutaneous site infections (PSI) are a serious complication during the post-implant course. We sought to study the incidence, risk factors, and clinical effect of PSI.
Data were obtained from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Registry. All adult patients who received a primary intracorporeal continuous flow LVAD between June 2006 and September 2010 were included. Descriptive statistics, Kaplan-Meier depictions, and multivariable analysis in the parametric hazard domain were used for statistical analysis.
A total of 239 PSIs were documented in 197 of 2,006 recipients (9.8%) of a continuous-flow LVAD. Mean follow-up was 8.1 months. Mean time to development of a PSI was 6.6 months. At 1 year after implant, nearly 19% of continuous-flow LVAD recipients developed a PSI. Multivariate analysis showed younger age (hazard ratio, 1.20; p < 0.0001) was the only factor predicting a PSI. Continuous-flow LVAD recipients who did not develop a PSI had improved survival (p = 0.004). Twenty-three patients died after development of a PSI. Sepsis was the most common cause of death (26.1%).
PSIs occur in approximately 19% of continuous-flow LVAD recipients by 12 months after implant. Young age is the only predictor of PSI. Importantly, development of a PSI adversely affects survival. Efforts to enhance driveline integration and to develop future totally implantable systems are warranted.
尽管连续血流左心室辅助装置（LVAD）支持已成为标准疗法，但设备和患者管理的复杂性仍然是一个挑战。特别是，经皮部位感染（PSI）是植入后过程中的严重并发症。我们旨在研究 PSI 的发生率、风险因素和临床影响。
数据来自机械辅助循环支持机构间注册（INTERMACS）登记处。所有在 2006 年 6 月至 2010 年 9 月期间接受原发性体内连续流动 LVAD 的成年患者均被纳入。采用描述性统计、Kaplan-Meier 描述和参数风险域中的多变量分析进行统计分析。
在 2006 例接受连续血流 LVAD 的患者中，有 197 例（9.8%）记录了 239 例 PSI。平均随访时间为 8.1 个月。PSI 发展的平均时间为 6.6 个月。植入后 1 年，近 19%的连续血流 LVAD 接受者发生了 PSI。多变量分析显示，年龄较小（风险比，1.20；p<0.0001）是预测 PSI 的唯一因素。未发生 PSI 的连续血流 LVAD 接受者的生存率提高（p=0.004）。23 例患者在发生 PSI 后死亡。败血症是最常见的死亡原因（26.1%）。
在植入后 12 个月，约有 19%的连续血流 LVAD 接受者发生 PSI。年龄较小是 PSI 的唯一预测因素。重要的是，PSI 的发展对生存率有不利影响。值得努力增强传动系统集成并开发未来的完全可植入系统。
