Epidemiology, Outcomes, and Effects of Device Flow Type on Ventricular Assist Devices (VAD) Infections: An IMACS Registry Analysis

Abstract

Purpose Infection remains an important cause of morbidity and mortality in continuous flow ventricular assist device (CF-VAD) recipients. It is unclear if flow type (axial or centrifugal) is associated with VAD infection and post-infection outcomes. This study aimed to investigate the device flow-type-specific rates of VAD infection and subsequent outcomes. Methods We analyzed IMACS adult patients with CF-LVADs from 2013-2017. We defined VAD infection using the ISHLT definitions as both VAD-specific infections including driveline, pump pocket/interior/exit cannula infection, and VAD-related infections including mediastinitis and VAD-related bloodstream infection. We compared the rates of VAD infections and post-infection events by flow type. Results Patients with axial devices (N=9988) had both higher early ( 3 months) rates (per 100 patient-months) of developing VAD infections compared to those with centrifugal (N=5572; Early: 2.3 vs. 1.8, p Conclusion VAD infection rates were higher in axial devices both in the early and late time periods following device implant; younger patients had a higher hazard of VAD infection in this group. VAD infection was associated with higher bleeding and mortality in both flow type groups. Infection prevention programs specifically targeting VAD infections should be a key component of VAD research.