Left ventricular assist device driveline infections in three contemporary devices

Area of Science:

• Cardiology
• Medical Devices
• Infectious Diseases

Background:

• Driveline infections (DLIs) are frequent complications in patients with left ventricular assist devices (LVADs).
• DLIs can lead to severe patient outcomes, including hospital readmissions and increased healthcare costs.
• Identifying risk factors for DLI readmission is crucial for improving patient management post-LVAD implantation.

Purpose of the Study:

• To characterize risk factors associated with DLI readmission within two years following LVAD implantation.
• To compare the incidence of DLI readmission across different LVAD device types: HeartMate II (HMII), HeartMate 3 (HM3), and HVAD.
• To investigate potential early biomarkers for DLI readmission.

Main Methods:

• A retrospective single-center study analyzed data from 183 LVAD patients implanted between 2013 and 2017.
• Patient demographics, clinical parameters, and outcomes, including DLI events and readmissions, were collected and analyzed.
• Statistical analysis was performed to identify risk factors and compare outcomes between device groups.

Main Results:

• 12.6% of patients were readmitted for DLI, while 14.8% were treated for DLI in an outpatient setting.
• Patients readmitted for DLI exhibited higher mean C-reactive protein, leukocyte, and fibrinogen levels compared to those with outpatient DLI or no DLI, detectable as early as 60 days prior.
• Freedom from DLI readmission was significantly lower for HeartMate 3 (72%) compared to HeartMate II (98%) and HVAD (87%) (P=0.03).

Conclusions:

• DLI readmission remains a significant concern after LVAD implantation.
• Elevated C-reactive protein, leukocytes, and fibrinogen levels may serve as early indicators for DLI readmission risk.
• The HeartMate 3 device is associated with a higher risk of DLI readmission compared to HeartMate II and HVAD, potentially due to device-specific driveline design.