(528) - Effectiveness of Continuous Flow Left Ventricular Assist Device Exchange for Recurrence of Major Drive Line and Pump Pocket Infection

Abstract

Effectiveness of Continuous Flow Left Ventricular Assist Device Exchange for Recurrence of Major Drive Line and Pump Pocket Infection. To evaluate effectiveness of continuous flow left ventricular assist device (CF-LVAD) exchange for recurrence of major drive line infection (DRI) and pump pocket infection (PPI). A total of 328 patients underwent implantation of CF-LVAD (median age 56 years; 77% male). Overall 59/328 (18%) required hospitalization for treatment of DRI or PPI (0.16 events per patient year-support) with 15/59 (4.5%) patients receiving pump exchange (PE) (total 20 PE; 1.33 devices per patient) after a median 22 [11,31] months of support. Similar CF-LVADs were used at the time of PE. DRI alone was the indication in 14/20 (70%) PE and PPI with or without DRI was the indication for PE in 6/20 (30%). A median 2 [1,3] admissions were required for non-PE treatment for DRI or PPI prior to decision for PE. Complete sternotomy was employed in 18/20 (90%) and subcostal approach was undertaken in 2/20 (10%) PE. Omental Transposition (n=7; 35%) was performed in all 6 patients with PPI and in 1 patient with DRI. Median hospital length of stay (LOS) was 13 [10,19] days. Following discharge a median of 1 [0,3] readmissions were required for infection, stroke or major GIB. Survival at 30 days and 6 months following PE was 100% and 86%, respectively. Patients undergoing omental transposition had a trend towards lower mean readmission rate, infection-related readmission rate, and hospital LOS (16 vs 18 days). At 6 months, PE for presumed DRI was associated with 55 ± 15% freedom from recurrence of device related infections however at 6 months, PE with omental transposition for confirmed PPI demonstrated 75 ± 21% freedom from recurrence of device related infections. CF-LVAD PE is associated with acceptable morbidity and mortality. Omental transposition provided durable freedom from re-infection in patients with PPI and DRI.