Iyengar Amit, Feinman Jason, Jiang Joyce, Song Cindy, Kim Spencer, Mathew Alvin, Golec Sophia, Rao Aarti, Radakrishnan Ankitha, Asher Michaela, Rekhtman David, DePaolo John, Moss Noah, Itagaki Shinobu, Anyanwu Anelechi, Wald Joyce, Cevasco Marisa, Parikh Aditya
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cardiovascular Medicine, Mount Sinai Health Systems, New York, New York.
JHLT Open. 2025 Jan 17;8:100208. doi: 10.1016/j.jhlto.2025.100208. eCollection 2025 May.
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.
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.
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.
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.
左心室辅助装置特异性感染（LSIs）仍然是长期使用左心室辅助装置（LVADs）的患者面临的一个持续存在的问题。然而，感染病原体及相关发病率仍未明确。我们试图评估在两家三级医疗中心接受现代离心式LVADs治疗的患者中LSIs的发病率、流行病学特征及相关发病率。
对2015年1月1日至2021年3月31日在宾夕法尼亚大学和西奈山医疗系统接受HeartMate 3植入的成年患者进行回顾性分析，随访至2022年3月31日。患者按LSIs病史分组，LSIs定义为培养阳性感染和/或需要药物或手术干预的感染。查询人口统计学数据、可用的培养数据、药物干预和手术干预情况。生存分析在4年时进行截尾，并根据感染时间的第25百分位数设定里程碑。
在206例LVAD接受者中，71例（34.5%）发生了LSIs。主要病原体为[具体病原体1]（47.9%）、[具体病原体2]（15.5%）和[具体病原体3]（8.5%）。感染的预测因素包括黑人种族（LSIs组与无LSIs组：46.2%对29.2%，P = 0.021）和体重指数（中位数分别为29.7和26.2 kg/m²，P = 0.007）。感染的中位时间为231天（112 - 423天），19例（26.8%）患者需要手术清创。设定里程碑后的生存率无差异（对数秩检验P = 0.830）。因感染相关原因，LSIs患者额外住院8天（0 - 28天）。
LSIs仍然普遍存在，大多数与[具体病原体1]、[具体病原体2]和[具体病原体3]有关，并且与再住院负担显著增加相关。26.8%的患者接受了手术干预。持续努力了解和预防LSIs对于改善LVAD患者的护理是必要的。
