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Outcomes After Infections in Adolescents and Young Adults with Continuous-Flow Left Ventricular Assist Devices

Sharon Chen1, Ryan S Cantor2,3, Scott Auerbach4

  • 1From the Stanford University, Palo Alto, California.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 16, 2018
PubMed

Insights

Infections after ventricular assist device (VAD) implantation increase mortality in adolescents but raise stroke risk in young adults. This study highlights age-specific outcomes following VAD infections in bridged-to-transplant patients.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Transplant Surgery

Background:

  • Infections in adult ventricular assist device (VAD) patients are linked to higher mortality and stroke risk.
  • Outcomes after VAD infections in younger populations, particularly adolescents and young adults, are less understood.
  • Diabetes and obesity, common risk factors in adults, are less prevalent in younger VAD patients.

Purpose of the Study:

  • To investigate the impact of infections on outcomes in adolescents and young adults receiving continuous-flow VADs as a bridge to transplant.
  • To compare mortality and stroke risk following VAD infections between adolescent and young adult patient groups.

Main Methods:

  • Utilized data from the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and Interagency Registry for Mechanical Circulatory Support.
  • Included patients aged 12-29 years with continuous-flow VADs implanted between September 2012 and March 2016 as bridge to transplant.
  • Employed Kaplan-Meier and Cox proportional hazard models to analyze the effect of infection on death and clinical stroke.

Main Results:

  • Included 92 adolescents (12-18 years) and 224 young adults (19-29 years), totaling 3,748 patient-months of follow-up.
  • Adolescents had smaller body surface area and higher Interagency Registry for Mechanical Circulatory Support profiles; no differences in diabetes/obesity.
  • Post-infection mortality risk increased significantly in adolescents (HR 8.2, p=0.01), while stroke risk increased in young adults (HR 3.1, p=0.01).

Conclusions:

  • Adolescents with VADs experience increased mortality after infections, contrasting with young adults who face elevated stroke risk.
  • These age-dependent outcomes suggest that both pre- and post-implant factors contribute to differing results.
  • Further research is needed to elucidate the specific mechanisms driving these divergent outcomes in younger VAD populations.

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