Mortality following Durable Left Ventricular Assist Device Implantation by Timing and Type of First Infection

ABSTRACT Purpose While infections are common following left ventricular assist device (LVAD) implantation, the relationship between timing and type of first infection with regards to mortality is less well understood. Methods The Society of Thoracic Surgeons Intermacs patients receiving a primary LVAD from 4/2012 to 5/2017 were included. The primary exposure was defined 3 ways: any infection, timing of first infection (early: ≤90d; intermediate: 91-180d; late: >180d), and type (VAD-specific, VAD-related, non-VAD). The association between first infection and all-cause mortality was estimated using Cox regression. Results The cohort included 12,957 patients at 166 centers (destination therapy: 47.4%, bridge-to-transplant: 41.2%). First infections were most often non-VAD (54.2%). Rates of first infection were highest in the early interval (10.7/100 person-months). Patients with any infection had a significantly higher adjusted hazard of death [HR 2.63 (2.46-2.86)]. First infection in the intermediate interval was associated with the largest increase in adjusted hazard of death [HR3.26 (2.82-3.78)], followed by late [HR3.13 (2.77-3.53)] and early intervals [HR2.37 (2.16-2.60)]. VAD-related infections were associated with the largest increase in hazard of death [HR3.02 (2.69-3.40)], followed by VAD-specific [HR2.92 (2.57- 3.32)], and non-VAD [HR 2.42 (2.20-2.65)]. Conclusions Relative to those without infection, patients with any post-implantation infection had an increased risk of death. VAD-related infections and infections occurring in the intermediate interval were associated with the largest increase in risk of death. Following LVAD implantation, infection prevention strategies should target non-VAD infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.