Increased Risk of Stroke and Death in Ventricular Assist Device Patients Varies by ISHLT Infection Category: An INTERMACS Analysis

Purpose Ventricular assist device (VAD) patients experience infections, which increase the risk of stroke and mortality. We aimed to characterize key differences in clinical outcomes for VAD patients based on the ISHLT categorization of infections: VAD-specific (e.g. pump component related), VAD-related (e.g. bloodstream infection, BSI) and non-VAD infections (e.g. pneumonia). Methods Query of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) identified 16,597 continuous-flow VAD recipients. Categories of infection were tested in multivariate models to determine the risk of stroke and death. Results After implant, 7,046 patients (42%) developed an infection at a median of 69 days (IQR: 12-272). A majority were non-VAD infections (49%) followed by VAD-related (26%) and VAD-specific infections (25%). Non-VAD and VAD-related infections had an incidence of 0.83 events/patient-year (EPPY) compared to 0.64 EPPY for VAD-specific infections (p Conclusion The ISHLT categorization of VAD infections unveils notable differences in associated risk of stroke and mortality. A re-assessment of transplant prioritization for eligible infected VAD patients may be useful to increase transplant related survival benefit.