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Updated: May 20, 2025
Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Epidemiology and impact of device-specific infections on patients receiving left ventricular assist devices
Amit Iyengar1, Jason Feinman2, Joyce Jiang3
1Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Background:
Left ventricular assist device-specific infections (LSIs) remain a persistent problem facing patients with durable left-ventricular assist devices (LVADs). However, the infectious agents and associated morbidity remained poorly defined. We sought to evaluate the incidence, epidemiology, and morbidity associated with LSIs in patients receiving modern centrifugal LVADs at 2 tertiary care centers.
Methods:
Retrospective analysis was performed of adult patients receiving HeartMate 3 implants at the University of Pennsylvania and Mount Sinai Health Systems from January 1, 2015 to March 31, 2021, with follow-up until March 31, 2022. Patients were grouped by history of LSI, defined as culture-positive infections and/or those requiring medical or surgical intervention. Demographic data, available culture data, medical interventions, and surgical interventions were queried. Survival analysis was censored at 4 years and landmarked according to 25th percentile time-to-infection.
Results:
Among 206 LVAD recipients, 71 (34.5%) developed an LSI. Predominant organisms were Staphylococcus (47.9%), Pseudomonas (15.5%), and Serratia (8.5%). Predictors of infection included Black race (LSI vs No LSI: 46.2% vs 29.2%, p = 0.021) and body mass index (median 29.7 vs 26.2 kg/m2, p = 0.007). Median time to infection was 231 days (112-423), with 19 (26.8%) patients requiring surgical debridement. Landmarked survival did not differ (log-rank p = 0.830). LSI patients were hospitalized an extra 8 (0-28) days for infection-related reasons.
Conclusion:
LSIs remain pervasive, with most related to Staphylococcus, Pseudomonas, and Serratia, and are associated with significantly increased rehospitalization burden. Surgical interventions were utilized in 26.8% of patients. Continued efforts to understand and prevent LSIs are necessary to improve care for LVAD patients.
Insights
Left ventricular assist device-specific infections (LSIs) affect over a third of patients, commonly caused by Staphylococcus, Pseudomonas, and Serratia. These infections increase hospitalization but do not impact survival.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Left ventricular assist device-specific infections (LSIs) are a significant complication for patients with durable left-ventricular assist devices (LVADs).
- The specific infectious agents and associated patient morbidity for LSIs have been poorly defined.
- This study evaluates the incidence, epidemiology, and morbidity of LSIs in patients with modern centrifugal LVADs.
Purpose of the Study:
- To determine the incidence and epidemiology of left ventricular assist device-specific infections (LSIs).
- To assess the morbidity associated with LSIs in patients receiving modern centrifugal LVADs.
- To identify predictors and common causative organisms of LSIs.
Main Methods:
- Retrospective analysis of adult patients with HeartMate 3 LVAD implants from January 2015 to March 2021.
- Patients were grouped based on the presence of LSI, defined by culture-positive infections or need for intervention.
- Demographic data, culture results, and interventions were analyzed, with survival analysis censored at 4 years.
Main Results:
- Of 206 LVAD recipients, 71 (34.5%) developed an LSI.
- Predominant infectious agents included Staphylococcus (47.9%), Pseudomonas (15.5%), and Serratia (8.5%).
- Black race and higher body mass index were predictors of LSI. Patients with LSI experienced an additional 8 days of hospitalization.
Conclusions:
- LSIs are common in LVAD patients, primarily caused by Staphylococcus, Pseudomonas, and Serratia.
- LSIs are associated with increased rehospitalization but not significantly different survival rates.
- Further research and prevention strategies are crucial for improving LVAD patient care.
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