Etiology of Continuous-Flow LVAD (CF-LVAD) Infections

Purpose Infection is a frequent problem following CF-LVAD implantation. We were interested in determining the spectrum of infectious complications following implantation of HeartMate II (HMII) and Heartware (HW) CF-LVADs. Methods We reviewed 893 HMII and HW implants from 1999 to 2018 performed at our institution. Infections were classified as device-specific (superficial/deep driveline infection or pocket/device infection) or as device-related (bacteremia). Other infections, such as urinary tract infections, central line infections, and pneumonia were recorded, but are not analyzed here. Etiology of the infection was also recorded. In some infections, multiple infectious agents were cultured. Results 801 CF-LVADs were implanted; 542 HMIIs, and 256 HWs. 180/542 (33.2%) of HMII, and 70/256 (27.3%) of HW pumps developed an infection. The incidence of infection / support year was 20.6% for HMII pumps and 20.3% for HW pumps. Driveline infections (superficial or deep) occurred in 136/542 (25.1%) HMII implants and in 53/250 (21.2%) HW implants. Pocket/device infections occurred in 102/542 (18,8%) HMII pumps and in 23/256 (9.0%) HW pumps. Bacteremia occurred in 84/542 (15.1%) HMII pumps and in 28/256 (10.9%) HW pumps. Staph aureus, pseudomonas, and coagulase negative species were the most common isolates (see Table). Median time to first infection was not statistically different (p=748) between HMII (1021 days) and HW devices (1273 days); (See Figure). Conclusion Infection continues to be a major problem after CF-LVAD implantation. Driveline infections, both superficial and deep, as well as pocket and device infections occur commonly after both HMII and HW implants.