Original clinical scienceInfectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation
Section snippets
Study design
We conducted a retrospective review of all patients undergoing LVAD implantation at our institution (June 2000 to May 2009) after institutional review board approval. Patients were stratified by device type (CF HeartMate II vs PF HeartMate XVE; Thoratec Corp., Pleasanton, CA) as well as year of implantation for analysis. Relevant baseline, operative, and post-operative data were collected. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Seattle Heart Failure Model (SHFM)
Baseline characteristics and pre-operative risk scores
One hundred thirty-three LVADs (47 PF and 86 CF) were implanted (Figure 1). Baseline demographic and physical characteristics were generally similar between groups (Table 1). CF patients had lower pre-operative risk, more recently implanted devices, longer duration of LVAD support, and a higher prevalence of automatic implantable cardioverter-defibrillators.
Infectious outcomes
Ninety-one (68%) patients developed sepsis. Of the patients with sepsis, 26 (28%) developed severe sepsis. Twenty (77%) patients with
Disclosure statement
This study was presented at the 28th annual meeting and scientific sessions of the International Society for Heart and Lung Transplantation, April 2008, Boston, MA.
This work was supported in part by a Ruth L. Kirschstein National Research Service Award (NIH 2T32DK007713-12 to E.S.W.).
The authors have no conflicts of interest to disclose.
References (35)
- et al.
Infection in permanent circulatory support: experience from the REMATCH trial
J Heart Lung Transplant
(2004) - et al.
Ventricular assist device-related infections
Lancet Infect Dis
(2006) - et al.
Nosocomial bloodstream infections in patients with implantable left ventricular assist devices
Ann Thorac Surg
(2001) - et al.
Infection in ventricular assist devices: prevention and treatment
Ann Thorac Surg
(2003) - et al.
Can the Seattle Heart Failure Model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy?
J Heart Lung Transplant
(2009) - et al.
INTERMACS database for durable devices for circulatory support: first annual report
J Heart Lung Transplant
(2008) - et al.
Revised screening scale to predict survival after insertion of a left ventricular assist device
J Thorac Cardiovasc Surg
(2003) - et al.
Evaluation of risk indices in continuous-flow left ventricular assist device patients
Ann Thorac Surg
(2009) - et al.
LVAD bloodstream infections: therapeutic rationale for transplantation after LVAD Infection
J Heart Lung Transplant
(2003) - et al.
Comparison of Novacor and HeartMate vented electric left ventricular assist devices in a single institution
J Heart Lung Transplant
(2005)
Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection
Circulation
Use of a continuous-flow device in patients awaiting heart transplantation
N Engl J Med
Advanced heart failure treated with continuous-flow left ventricular assist device
N Engl J Med
The influence of infection on survival and successful transplantation in patients with left ventricular assist devices
J Heart Lung Transplant
Nosocomial infections in left ventricular assist device recipients
Clin Infect Dis
Left ventricular assist device-related infection: treatment and outcome
Clin Infect Dis
Late-onset driveline infections: the achilles' heel of prolonged left ventricular assist device support
Ann Thorac Surg
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