(37) - Persistent Blood Stream Infections Are Associated with Cerebrovascular Accidents in Patients with Continuous Flow LVADs

Abstract

PurposeCommon adverse events in patients supported with continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection and CVA.MethodsCharts of patients who received HeartMate II (HMII) CF-LVADs from 2008-2012 at a single center were reviewed. Blood stream infection was divided into persistent and not persistent. Persistent BSI (pBSI) was defined as BSI with the same organism on repeat blood culture > 72 hours from initial blood culture despite antibiotics. Multivariate analysis was performed. KM curves constructed for survival and event-free survival (all cause CVA).ResultsA total of 149 patients had HMII implant; 76% were male and mean age was 55.4 ± 13 years. A total of 18 (12%) patients had CVA (6 HCVA and 12 ICVA) at a median of 294 days (range 5-1096 days) after implantation. A total of 28 (19%) patients had pBSI and 17 (11%) patients with non-persistent BSI (table1). Patients with pBSI had a greater BMI (31 vs. 27, p=0.09), and longer duration of support (959 days vs. 346 days) compared to those with non-pBSI. Persistent BSI was associated with an increased risk of all-cause CVA and mortality compared to those with non-persistent BSI or without BSI (figure 1A-B). Persistent BSI was predictive of outcome on multivariate analysis (OR 6.9, P=0.001). Pseudomonas bacteremia was highly associated with HCVA (r=0.595, p=0.0001).ConclusionFigView Large Image Figure ViewerDownload Hi-res image Download (PPT) PurposeCommon adverse events in patients supported with continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection and CVA. Common adverse events in patients supported with continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection and CVA. MethodsCharts of patients who received HeartMate II (HMII) CF-LVADs from 2008-2012 at a single center were reviewed. Blood stream infection was divided into persistent and not persistent. Persistent BSI (pBSI) was defined as BSI with the same organism on repeat blood culture > 72 hours from initial blood culture despite antibiotics. Multivariate analysis was performed. KM curves constructed for survival and event-free survival (all cause CVA). Charts of patients who received HeartMate II (HMII) CF-LVADs from 2008-2012 at a single center were reviewed. Blood stream infection was divided into persistent and not persistent. Persistent BSI (pBSI) was defined as BSI with the same organism on repeat blood culture > 72 hours from initial blood culture despite antibiotics. Multivariate analysis was performed. KM curves constructed for survival and event-free survival (all cause CVA). ResultsA total of 149 patients had HMII implant; 76% were male and mean age was 55.4 ± 13 years. A total of 18 (12%) patients had CVA (6 HCVA and 12 ICVA) at a median of 294 days (range 5-1096 days) after implantation. A total of 28 (19%) patients had pBSI and 17 (11%) patients with non-persistent BSI (table1). Patients with pBSI had a greater BMI (31 vs. 27, p=0.09), and longer duration of support (959 days vs. 346 days) compared to those with non-pBSI. Persistent BSI was associated with an increased risk of all-cause CVA and mortality compared to those with non-persistent BSI or without BSI (figure 1A-B). Persistent BSI was predictive of outcome on multivariate analysis (OR 6.9, P=0.001). Pseudomonas bacteremia was highly associated with HCVA (r=0.595, p=0.0001). A total of 149 patients had HMII implant; 76% were male and mean age was 55.4 ± 13 years. A total of 18 (12%) patients had CVA (6 HCVA and 12 ICVA) at a median of 294 days (range 5-1096 days) after implantation. A total of 28 (19%) patients had pBSI and 17 (11%) patients with non-persistent BSI (table1). Patients with pBSI had a greater BMI (31 vs. 27, p=0.09), and longer duration of support (959 days vs. 346 days) compared to those with non-pBSI. Persistent BSI was associated with an increased risk of all-cause CVA and mortality compared to those with non-persistent BSI or without BSI (figure 1A-B). Persistent BSI was predictive of outcome on multivariate analysis (OR 6.9, P=0.001). Pseudomonas bacteremia was highly associated with HCVA (r=0.595, p=0.0001). Conclusion