Infectious complications in children on ventricular assist device: A single-center retrospective cohort study

Mechanical circulatory support with ventricular assist device (VAD) is a life-saving therapy in children with end-stage heart failure. Infections are a major problem in VAD-therapy and may lead to significant morbidity and mortality. The aim of the study was to evaluate possible risk factors for superficial percutaneous lead/canula infections (SI) and to determine their impact on overall outcome during VAD-therapy.

Single center, retrospective analysis of infectious complications in 70 consecutive children supported on a VAD (58 Berlin Heart EXCOR Pediatric pulsatile flow pump and 12 Heartware continuous flow pump). Cox proportional hazard models with SI, bloodstream infections, and stroke as outcome, as well as a competing risk model for device weaning, death, and heart transplantation were used to identify risk factors in the study population.

SI were documented in twelve out of 70 children (17%). The event rate for SI was 5.86 per 100 patient months [95%CI 3.03-10.23] with a median time to SI of 109 days [IQR 66-163]. The occurrence of SI was mostly in patients with longer support times while the underlying diagnosis and previous thoracotomies had no impact on the number of SI. Further, children older than three years of age had a higher risk for SI (HR 2.67; 95% CI 1.09-6.57, p = 0.032). SI were not associated with the risk of bloodstream infections (HR 1.27; 95%CI 0.44-3.67, p = 0.656) or death (HR 0.32; 95% CI 0.06-1.80, p = 0.194).

SI occurred frequently during VAD therapy in children, without leading to a higher rate of bloodstream infections or mortality. Further, being above three years of age at VAD implantation was associated with increased risk to develop SI.