0399: Mechanical circulatory support and infection: a single center experience

Abstract

With the shortage of grafts, mechanical circulatory support has emerged as an alternative to heart transplantation. But one of the main disadvantages is the percutaneous source of energy that exposes to the risk of infection. We studied driveline infections occurred in a single-center prospective cohort of patients with long-term intracorporeal and continuous-flow left assist device type HeartMate II, between January 2008 and January 2014. Among the 34 devices implanted, we identified 9 cases of infection of the power cable (26.5%). The diagnosis was defined by the combination of a positive bacteriological sample with local inflammatory signs, ranging from skin redness to frank pus. The germs found included: 5 aureus staphylococci, 3 white staphylococci, 3 gram-negative bacilli including a pseudomonas aeruginosa, and a citrobacter. The median time to onset of infection was 15 months, ranging from 3 weeks to 2.5 years after implantation. Associated factors were: surgical re-opening, prolonged ICU stay, acute renal failure, the existence of a concomitant infection, malnutrition, duration of assistance and dressing changes at home. The treatment was based on a broad-spectrum antibiotics, secondarily adapted to the antibiogram and long lasting. Among these patients, two were transplanted, including one in the context of a Type 2 Super Emergency, two others died of a non-infectious cause, one patient is now cured and four are still carrying a chronic related-device infection. The management of end-stage heart failure has improved thanks to our growing experience in the field of long-term assistance, but the driveline infection is a major complication. It greatly affects the quality of life of the patients and transplantation may be the only prospect of recovery.