Abstract
Purpose Left ventricular assist device (LVAD) exchange for source control of infection has been suggested as a treatment option for LVAD-associated infections (LVADI). However, there are limited data regarding the efficacy and outcomes of these patients. We reviewed the clinical outcomes of patients undergoing a device exchange in the presence of persistent and severe VAD-specific and VAD-related infections. Methods We retrospectively reviewed all patients (n=80) at our center who underwent a CF-LVAD exchange between January 2005 and October 2016. Patients with a LVADI, defined using the International Society of Heart and Lung Transplant criteria were further evaluated. The primary outcomes included freedom from recurrent or new LVADI and survival at 1 and 2 years following pump exchange. Results A total of 31 (39% of 80) patients had a LVADI at time of device exchange. Median age was 59 years, 25 (81%) male, 26 (84%) HeartMate 2, and 29 (94%) destination therapy. Indication for exchange was 9 (29%) infection, 10 (32%) hemolysis, and 12 (39%) device failure. Median duration of support prior to infection was 1.1 years (range, 4 days - 4.4 years). The most common pathogens were S. aureus (23%), Pseudomonas (19%), and coagulase negative staphylococci (13%). Overall median duration from onset of LVADI to exchange was 270 days (range, 4 days - 2.4 years). The median time from onset of LVADI to exchange was shorter in patients with no recurrence of LVADI compared to patients with recurrence (140 vs. 348 days). At one-year post-exchange; ten (32%) patients had recurrence with the same pathogen after a median duration of 25 days, 6 (19%) with a new pathogen after a median duration of 90 days, and 12 (39%) were infection free. The 30-day mortality was 3 (10%) patients. Overall, 16 (51%) patients had recurrent or new LVADI at 1 year and 19 (62%) at 2 years post-exchange. Survival at 1 and 2 years was 52% and 36% and cause of death in most patients was HCVA at 42% and 50%, respectively. Conclusion For patients receiving a pump exchange with a LVADI, this study suggests a lower incidence of recurrent LVADI with earlier device exchange. While device exchange should remain a consideration for difficult LVADI, it is associated with significant risk of morbidity and mortality at 1 and 2 years. Additional studies are needed to better define management strategies in patients undergoing a device exchange for the control of infection.
Published Version
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