THE INFLUENCE OF INFECTION ON SURVIVAL AND SUCCESSFUL TRANSPLANTATIONIN PATIENTS WITH LEFT-VENTRICULAR ASSIST DEVICES

Background: Mechanical cardiac assistance has recently emerged as a te nable option in the treatment of end-stage heart failure. In spite of recent technical improvements that have reduced the incidence of life- threatening complications, the reported frequency of infections in the se patients has remained high. Methods: Over a 5-year period, 60 patie nts underwent insertion of a left ventricular assist device (LVAD) at our institution. Detailed medical records were kept prospectively for all patients, and a variety of endpoints were analyzed, including the incidence, nature, and sequelae of infections before and after LVAD im plantation and after transplantation. Results: Twenty-nine of 60 patie nts (48%) undergoing LVAD insertion subsequently had development of in fections. The most frequent sites of infection were blood, LVAD drivel ines, and central venous catheters, representing 61% of all infections . At the time of LVAD implantation, 13 of 60 patients (22%) had cultur e-proven infections. In spite of an increased incidence of subsequent infection (77% vs 40%), there were no differences in rates of mortalit y (31% vs 26%), LVAD endocarditis, (23% vs 11%) and eventual transplan tation (62% vs 57%) between these patients and those without periimpla ntation infections. Although the overall mortality rate was not influe nced by infections during LVAD support (28% vs 26%), the development o f LVAD endocarditis was associated with a high mortality rate. Finally , although patients with infections during LVAD support had significan tly longer median support times than those who remained infection free (101 vs 49 days, respectively), there was no difference in the rate o f successful transplantation (59% vs 58%) or in the rate of infection after transplantation (35% vs 28%). Conclusions: Infections are common in patients undergoing LVAD support, but they do not adversely affect survival, the rate of successful transplantation, or the incidence of posttransplantation infection. Periimplantation infections may increa se the risk of subsequent infections, but they also do not influence s urvival or transplantability. Patients with development of LVAD endoca rditis are at increased risk for morbidity and death and require early and aggressive therapy, potentially including device explantation.