1175. Tandem Heart-Associated Fevers: Does the Fever Signify Infection?

Abstract

BackgroundTandem Heart (TH) is a percutaneously inserted ventricular assist device, this unique device connects an extracorporeal axial flow pump to a catheter that crosses the atrial septum and aspirates blood from the left atrium which is returned to the femoral artery. TH is used as a bridge to transplantation or to another surgically inserted device. Fever was noted in patients after TH insertion. The objective of this study was to evaluate whether the fever after TH insertion is associated with an infection.MethodsA retrospective review in a 680-bed tertiary care hospital from 2013 to 2016. Patients with TH were included. Data were collected on demographics, clinical presentation, onset and duration of fever, type of infections when present, and outcome. Student t-test was used for analysis.ResultsTH was inserted in 52 patients; males 41 (79%), mean age 56 years (range 25–80) Indication for TH was an acute exacerbation of congestive heart failure in 37/52 (71%) and cardiogenic shock with acute cardiomyopathy in 15/52 (29%). Mean duration of TH 9.4 days (Range: 1–29). Comorbidities were DM 19 (37%), hypertension 23 (44%), chronic kidney disease (CKD) 13 (25%), smoking 10 (19%). Fever within 72 hours of TH insertion was noted in 23/52(44%), of these 6/23(26%) had a documented infection. Pneumonia in 3, Clostridium difficile colitis 1, candida line infection 1 and 1 patient had both pneumonia and Enterobacter bacteremia. The fever lasted an average of 127 hours in patients with a documented infection vs. 45 hours in patients without a documented infection. (P = 0.08). The duration of TH in patients with infection was 14 days (range: 6–22 days) and in patients without infection was 8 days (range: 1–29 days) (P = 0.07). Mortality was noted in 5/6 (83%) patients with infection and in 5/17 patients (29%) without infection (P = 0.28). No clear etiology was found in patients with fever without a documented infection.ConclusionIn our patients with TH, fever was a prominent clinical feature; however infection was seen in only a quarter of patients after TH insertion. Fever duration was significantly longer in patients with a documented infection and their device was present for a longer duration. The mortality was higher in patients with fever and infection. The reason for fever without a documented infection remains obscure and requires further investigation.Disclosures All authors: No reported disclosures.