Prevalence and Risk Factors for Ventricular Assist Device-Associated Infection in Children: An Analysis ACTION Study

Ventricular assist devices (VAD) are increasingly used to bridge children to heart transplantation, but infection is common. The aim of this study was to determine contemporary prevalence and risk factors for VAD-associated infection in children.

A retrospective analysis of the ACTION registry evaluated patients with left or single VAD from 01/04/18-04/30/25. Patients were classified by intracorporeal (IC) vs. paracorporeal (PC) VAD and temporary vs. durable paracorporeal cannulas at infection. Patients with and without VAD-associated infection were compared overall and by VAD type. Risk factors for and one-year survival after infection were evaluated with multivariate analyses.

Of 1527 patients, 442 (28.9%) were on IC and 1085 (71.1%) on PC VAD (964 durable, 121 temporary cannulas). There were 152 (10%) patients who developed VAD-associated infection, with no difference in one-year survival. While more patients on PC VAD developed infection overall (PC: n = 94 vs. IC: n = 58), IC VAD patients had a proportionately higher infection rate (13.1% vs. PC durable 9.3% vs. PC temporary 3.3%) (p < 0.05). Median time to infection was later for IC vs. PC VAD (143 vs. 52.5 days, p < 0.0001). Children with infection were more likely to have severe obesity (17.2% vs. 7.8%) and to be on IC VAD (38.2% vs. 27.9%).

Nearly 1 in 10 children developed a VAD-associated infection, with no difference in one-year survival. Infection was proportionately higher for IC vs. PC VAD, likely driven by longer time on device. Innovations in driveline management for IC VAD may decrease morbidity for those on long-term support.