Risk factors and prognostic impact of left ventricular assist device-associated infections

Abstract Background Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors and prognosis of LVAD-associated infections. Methods Patients included in the ASSIST-ICD study (19 centers) were enrolled. The main outcome was the occurrence of LVAD associated infection (driveline infection, pocket infection or pump/cannula infection) during follow-up. Results Of the 652 patients enrolled, 201 (30.1%) presented a total of 248 LVAD infection, diagnosed 6.5 months after implantation, and including 171 (26.2%), 51 (7.8%) and 26 (4.0%) percutaneous driveline infection, pocket infection or pump/cannula infection, respectively. Patients with infections were aged 58.7 years, and most received HeartMate II (82.1%), or HeartWare (13.4%). Most patients (62%) had implantable cardioverter defibrillators (ICD) prior to LVAD and 104 (16.0%) had ICD implantation, extraction or replacement after the LVAD surgery. Main pathogens found among the 248 infections were Staphylococcus aureus (n = 113, 45.4%), Enterobacteriaceae (n = 61, 24.6%), Pseudomonas aeruginosa (n = 34, 13.7%), coagulase-negative staphylococci (n = 13, 5.2%), and Candida sp. (n = 13, 5.2%). In multivariable analysis, HeartMate II (sub hazard-ratio (sHR): 1.56, 95% CI:1.03–2.36; P  = .031) and ICD-related procedures post-LVAD (sHR: 1.43, 95% CI: 1.03–1.98; P  = .031), were significantly associated with LVAD infections. Infections had no detrimental impact on survival. Conclusions LVAD-associated infections affect one-third of LVAD recipients, mostly related to skin pathogens and Gram-negative bacilli, with increased risk with HeartMate II, as compared to HeartWare, and in patients who required ICD-related procedures post-LVAD. This is a plea to better select patients needing ICD implantation/replacement after LVAD implantation.