Management and Outcome of Left Ventricular Assist Device Infections in Patients Undergoing Cardiac Transplantation

Zerelda Esquer Garrigos; Natalia E Castillo Almeida; Pooja Gurram; Prakhar Vijayvargiya; Cristina G Corsini Campioli; John M Stulak; Stacey A Rizza; Larry M Baddour; M Rizwan Sohail

doi:10.1093/ofid/ofaa303

Management and Outcome of Left Ventricular Assist Device Infections in Patients Undergoing Cardiac Transplantation

Open Forum Infect Dis. 2020 Jul 20;7(8):ofaa303. doi: 10.1093/ofid/ofaa303. eCollection 2020 Aug.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Rochester, Minnesota, USA.
² Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
³ Department of Cardiovascular Surgery, Rochester, Minnesota, USA.
⁴ Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.

Abstract

Background: Postoperative management of patients undergoing cardiac transplantation with an infected left ventricular assist device (LVAD) is unclear.

Methods: We retrospectively screened all adults with an LVAD who underwent cardiac transplantation at our institution from 2010 through 2018. We selected all cases of LVAD-specific and LVAD-related infections who were receiving antimicrobial therapy as initial treatment course or chronic suppression at the time of cardiac transplantation. Non-LVAD infections, superficial driveline-infection, or concurrent use of right ventricular assist device or extracorporeal membrane oxygenation device were excluded.

Results: A total of 54 cases met study criteria with 18 of 54 (33.6%) classified as LVAD- specific or related infections and 36 of 54 (66.6%) as noninfected. cases of lvad infection had a higher median charlson comorbidity Index score at the time of transplantation compared with noninfected cases (P = .005). Of the 18 cases of infection, 13 of 18 (72.2%) were classified as LVAD-specific and 5 of 18 (27.8%) were classified as LVAD-related. Nine of 13 (69.2%) cases had proven LVAD-specific infections. Antimicrobial therapy was extended posttransplant to treat preceding LVAD-specific infection in all 9 cases (9 of 13, 69.2%) with a median duration of 14 days (interquartile range, 14-28). After LVAD removal, antimicrobial treatment was not continued for preceding LVAD-related infections.

Conclusions: Patients with an LVAD-specific infection were treated with 2 weeks of pathogen-directed therapy postheart transplant without any relapses. For those without LVAD-specific infection or uncomplicated LVAD-related bacteremia who had completed antimicrobial therapy pretransplant, antibiotics were discontinued after standard perioperative prophylaxis and no relapses were observed.

Keywords: heart transplant; left ventricular device infections; management; outcomes.