Original clinical science
Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation

https://doi.org/10.1016/j.healun.2010.08.003Get rights and content

Background

Infection is a significant source of morbidity and mortality after left ventricular assist device (LVAD) implantation. Newer generation continuous-flow (CF) LVADs are smaller, requiring smaller pump pockets and drive-line exit sites as compared with pulsatile-flow (PF) devices. With their recent adoption, CF device patients benefit from improved provider experience in the detection and treatment of infectious complications. Given these advances in design and experience, we examined the incidence of infectious complications in patients receiving CF and PF devices.

Methods

We reviewed patients who received CF or PF LVADs (June 2000 to May 2009) at our institution. Incidences and timing of systemic infections (bacteremia, sepsis, severe sepsis, septic shock), device-associated infections (drive-line, LVAD pocket, sternal wound) and non–device-associated infections (catheter-related bloodstream, pneumonia, urinary tract) were compared between devices. Primary outcomes were sepsis, severe sepsis, a composite of drive-line and LVAD pocket infection, and catheter-related bloodstream infection.

Results

Of 133 LVADs, 86 were CF. CF patients had lower pre-operative risk, more recent device implantation, and longer LVAD support time. Device type was highly correlated with reduced infections; however, on multivariate analysis, implantation date appeared to drive this association. Kaplan–Meier estimates of freedom from all primary outcomes were improved with more recent implantation (p < 0.05). On multivariate analysis, implantation date was predictive of all primary outcomes except severe sepsis, for which advanced age and worse Seattle Heart Failure Model score were predictive.

Conclusion

In this institutional review of post-LVAD infections, a decrease in infectious complications in CF patients was likely related to increased provider experience associated with a more recent date of 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.

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