A Prospective, Multicenter Study of Ventricular Assist Device Infections
Background—Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections.
Methods and Results—150 patients scheduled for VAD implantation were enrolled (2006-2008) at 11 U.S. cardiac centers and followed prospectively up to transplantation, explantation for recovery, death, or for one year. 86 (57%) patients received Heartmate II® devices. Data were collected on potential pre-, intra-, and post-operative risk factors for infection. Clinical, laboratory, and microbiologic data were collected for suspected infections and evaluated by an infectious diseases specialist. 33 (22%) subjects developed 34 VAD-related infections with an incidence rate of 0.01 per 100 person-days (95% CI, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but Pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (HRadj=2.8,P=0.007 and HRadj=1.7,P=0.023, respectively). The Heartmate II® was not associated with a decreased risk of infection. VAD infection increased one-year mortality (HRadj=5.6, P<0.0001).
Conclusions—This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence as it adversely affects patient survival.
Clinical Trial Registration Information—clinicaltrials.gov. Identifier: NCT01471795.
- Received July 3, 2012.
- Accepted December 21, 2012.
- Copyright © 2013, Circulation