Olmsted Randall Z, Critsinelis Andre, Kurihara Chitaru, Kawabori Masashi, Sugiura Tadahisa, Civitello Andrew B, Morgan Jeffrey A
Division of Cardiothoracic Transplant and Assist Devices, Baylor College of Medicine, Houston, Texas.
Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
J Card Surg. 2019 Feb;34(2):82-91. doi: 10.1111/jocs.13987. Epub 2019 Feb 2.
Left ventricular assist devices (LVADs) are being used more frequently for treating refractory, advanced heart failure. However, infection remains a frequent complication. In this study, we analyzed the incidence of severe infections in LVAD recipients to determine its impact on survival.
From May 2009 through March 2016, 437 patients with advanced heart failure underwent implantation of a continuous-flow LVAD (n = 314, HeartMate II LVAD [Abbott Laboratories, Abbott Park, IL]; n = 123 HeartWare HVAD [Medtronic, Minneapolis, MN]). We analyzed the rate of severe device infection requiring surgical intervention or involving sepsis and the impact of severe infection on outcomes in patients on long-term LVAD support.
Infection occurred in 244 patients (HeartMate II, n = 186; HVAD, n = 58); severe infections developed in 160 patients (HeartMate II, n = 119; HVAD, n = 41). HeartMate II recipients had 344 severe infection events (0.63 events per patient-year [EPPY]), whereas HeartWare recipients had 89 severe infection events (0.42 EPPY; P = 0.047). HeartMate II recipients had a higher incidence of pump infections (P < 0.001). Severe infections did not significantly affect survival (P = 0.42).
Although HeartMate II patients had a significantly higher incidence of pump infections requiring surgical treatment, survival was not adversely affected. The difference in postoperative infection rates may be an important factor in device type selection.
左心室辅助装置（LVADs）越来越频繁地用于治疗难治性晚期心力衰竭。然而，感染仍然是常见的并发症。在本研究中，我们分析了LVAD接受者严重感染的发生率，以确定其对生存的影响。
从2009年5月至2016年3月，437例晚期心力衰竭患者接受了连续流LVAD植入（n = 314，HeartMate II LVAD[雅培实验室，伊利诺伊州雅培公园]；n = 123，HeartWare HVAD[美敦力公司，明尼阿波利斯，明尼苏达州]）。我们分析了需要手术干预或涉及败血症的严重装置感染率，以及严重感染对长期接受LVAD支持患者结局的影响。
244例患者发生感染（HeartMate II，n = 186；HVAD，n = 58）；160例患者发生严重感染（HeartMate II，n = 119；HVAD，n = 41）。HeartMate II接受者有344次严重感染事件（0.63次事件/患者年[EPPY]），而HeartWare接受者有89次严重感染事件（0.42 EPPY；P = 0.047）。HeartMate II接受者的泵感染发生率更高（P < 0.001）。严重感染对生存没有显著影响（P = 0.42）。
尽管HeartMate II患者需要手术治疗的泵感染发生率显著更高，但生存并未受到不利影响。术后感染率的差异可能是装置类型选择的一个重要因素。
