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. 2023 Aug;166(2):570-579.e4.
doi: 10.1016/j.jtcvs.2021.10.056. Epub 2021 Nov 9.

Mortality following durable left ventricular assist device implantation by timing and type of first infection

Shiwei Zhou  1 , Guangyu Yang  2 , Min Zhang  2 , Michael Pienta  3 , Carol E Chenoweth  4 , Francis D Pagani  3 , Keith D Aaronson  5 , Michael D Fetters  6 , P Paul Chandanabhumma  6 , Lourdes Cabrera  3 , Hechuan Hou  3 , Preeti N Malani  4 , Donald S Likosky  3 ; Michigan Congestive Heart Failure Investigators
Affiliations

Mortality following durable left ventricular assist device implantation by timing and type of first infection

Shiwei Zhou et al. J Thorac Cardiovasc Surg. 2023 Aug.

Abstract

Objective: Although infections are common after left ventricular assist device implantation, the relationship between timing and type of first infection with regard to mortality is less well understood.

Methods: The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients receiving a primary left ventricular assist device from April 2012 to May 2017 were included. The primary exposure was defined 3 ways: any infection, timing of first infection (early: ≤90 days; intermediate: 91-180 days; late: >180 days), and type (ventricular assist device specific, ventricular assist device related, non-ventricular assist device). The association between first infection and all-cause mortality was estimated using Cox regression.

Results: The cohort included 12,957 patients at 166 centers (destination therapy: 47.4%, bridge-to-transplant: 41.2%). First infections were most often non-ventricular assist device (54.2%). Rates of first infection were highest in the early interval (10.7/100 person-months). Patients with any infection had a significantly higher adjusted hazard of death (hazard ratio, 2.63; 2.46-2.86). First infection in the intermediate interval was associated with the largest increase in adjusted hazard of death (hazard ratio, 3.26; 2.82-3.78), followed by late (hazard ratio, 3.13; 2.77-3.53) and early intervals (hazard ratio, 2.37; 2.16-2.60). Ventricular assist device-related infections were associated with the largest increase in hazard of death (hazard ratio, 3.02; 2.69-3.40), followed by ventricular assist device specific (hazard ratio, 2.92; 2.57-3.32) and non-ventricular assist device (hazard ratio, 2.42; 2.20-2.65).

Conclusions: Relative to those without infection, patients with any postimplantation infection had an increased risk of death. Ventricular assist device-related infections and infections occurring in the intermediate interval were associated with the largest increase in risk of death. After left ventricular assist device implantation, infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.

Keywords: infection; mechanical circulatory support; mortality; ventricular assist device.

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Figures

Figure 1.
Figure 1.
Cumulative Incidence of First Infection Following VAD Implant by Infection Type
Figure 2.
Figure 2.
The Effect of First Infection following LVAD-implant on Subsequent Mortality
See this image and copyright information in PMC

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