Continuous-flow devices and percutaneous site infections: clinical outcomes

J Heart Lung Transplant. 2012 Nov;31(11):1151-7. doi: 10.1016/j.healun.2012.05.004. Epub 2012 Jul 4.


Background: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

MeSH terms

  • Age Factors
  • Aged
  • Female
  • Follow-Up Studies
  • Heart-Assist Devices / adverse effects*
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Sepsis / epidemiology
  • Sepsis / etiology
  • Sepsis / mortality
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / etiology*
  • Surgical Wound Infection / mortality
  • Treatment Outcome
  • Ventricular Dysfunction, Left / therapy*