Incidence of Driveline Infections and Sepsis in a Contemporary HVAD Population

Abstract

We assessed the incidence of driveline infections (DLI) and sepsis in the HVAD population using pooled data from the ENDURANCE, ENDURANCE Supplemental, and Lateral trials. All HVAD patients enrolled in the Endurance (N=296), Endurance Supplemental (N=308), and Lateral (N=144) were assessed for DLI and sepsis events and separated into two groups: (1) driveline infection and (2) sepsis. Patients with both types were counted in both groups. Baseline characteristics and 24-month survival were compared intragroup to (1) patients with and without DLI and (2) patients with and without sepsis. Among the 748 patients implanted with an HVAD, 188 (25.1%) experienced 296 DLI and 137 (18.3%) experienced sepsis. Of the patients with DLI, 29 (15.4%) had subsequent sepsis. DLI occurred a mean of 538.5 days after implant (range 10-1729). Sepsis occurred a mean of 442 days post-implant (range 2-1792). Patients with DLI had larger BMI (28.4 ± 6 vs. 27.3 ± 5.6 kg/m2, p=0.02) at baseline. Patients with sepsis were older (65.7 ± 10.2 vs 61 ± 12.3 years, p<0.0001), had more ischemic HF (62.8% vs 49.6%, p=0.005), were more likely diabetic (51.1% vs 36.3%, p=0.001) (Table 1). Patients with DLI had better 2-year survival than those without DLI (88.1% vs 63.5%, p<0.0001). However, patients with sepsis had worse 2-year survival than those without sepsis (55.5% vs 73.9%, p<0.0001) (Figure 1). The incidence of DLI and sepsis remains stable in the LVAD population. Risk factors for sepsis include diabetes and ischemic etiology. While sepsis is a risk factor for mortality, the occurrence of DLI does not have an adverse effect on survival.