VAD-Related and Specific Infections are Significantly Associated with an Increased Risk of Cerebrovascular Accidents in Patients Supported by a Ventricular Assist Device: An EUROMACS Analysis

Purpose In patients supported by a ventricular assist device (VAD) major infections are a frequently reported adverse event with increased morbidity and mortality. The purpose of this study was to investigate the possible association of infections and cerebrovascular accidents (CVAs). Methods An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying all patients aged ≥18 years with a LVAD or BiVAD implantation. Infections were categorized as VAD-specific infections, VAD-related infections and non-VAD infections. An extended Kaplan-Meier analysis for the risk of CVA and mortality with infection as a time-dependent covariate was performed. Furthermore, a multivariable cox proportional hazard model was performed including 24 variables. Results For this analysis 3784 patients were included, with 45 patients being supported by a BiVAD and 3739 by an LVAD. The majority of patients were male (83.2%) and 60.5% had an INTERMACS patient profile 2 or 3. During follow-up, 3108 major infections were identified in 1385 (36.6%) of the patients, while 673 CVAs were identified in 545 (14.4%) of the patients. Extended Kaplan-Meier analysis with first infection as time-dependent covariate revealed a hazard ratio for CVA of 1.95 (95% CI: 1.57-2.36; p Conclusion Both VAD-related and VAD-specific infections are associated with significant increased risk of CVA, but non-VAD infections are not.