Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices.

BACKGROUND

Left ventricular assist device-specific infections (LSIs) remain a persistent problem facing patients with durable left-ventricular assist devices (LVADs). However, the infectious agents and associated morbidity remained poorly defined. We sought to evaluate the incidence, epidemiology, and morbidity associated with LSIs in patients receiving modern centrifugal LVADs at 2 tertiary care centers.

METHODS

Retrospective analysis was performed of adult patients receiving HeartMate 3 implants at the University of Pennsylvania and Mount Sinai Health Systems from January 1, 2015 to March 31, 2021, with follow-up until March 31, 2022. Patients were grouped by history of LSI, defined as culture-positive infections and/or those requiring medical or surgical intervention. Demographic data, available culture data, medical interventions, and surgical interventions were queried. Survival analysis was censored at 4 years and landmarked according to 25th percentile time-to-infection.

RESULTS

Among 206 LVAD recipients, 71 (34.5%) developed an LSI. Predominant organisms were (47.9%), (15.5%), and (8.5%). Predictors of infection included Black race (LSI vs No LSI: 46.2% vs 29.2%,  = 0.021) and body mass index (median 29.7 vs 26.2 kg/m,  = 0.007). Median time to infection was 231 days (112-423), with 19 (26.8%) patients requiring surgical debridement. Landmarked survival did not differ (log-rank  = 0.830). LSI patients were hospitalized an extra 8 (0-28) days for infection-related reasons.

CONCLUSION

LSIs remain pervasive, with most related to , , and , and are associated with significantly increased rehospitalization burden. Surgical interventions were utilized in 26.8% of patients. Continued efforts to understand and prevent LSIs are necessary to improve care for LVAD patients.