Infectious complications and outcomes in children supported with left ventricular assist devices

Abstract

Infectious complications constitute a major cause of morbidity and death in adult patients supported with left ventricular assist devices (VADs). The incidence and patient outcomes related to infectious complications in pediatric patients on VAD support remain largely unknown. The aim of this study was to determine the incidence of infection among pediatric VAD recipients and to characterize the microbiology, associated risk factors, and clinical outcome. We conducted a retrospective record review of all patients undergoing VAD support for ≥2 weeks at Texas Children's Hospital from June 1999 to December 2011. Infections were categorized as VAD-specific, VAD-related, or non-VAD-related using the International Society for Heart and Lung Transplantation (ISHLT) definitions for VAD infections. Fifty-two VADs were implanted in 51 patients; of these, 35 patients (69%) had 92 infections while receiving VAD support. These included 10 VAD-specific infections, 23 VAD-related infections, and 59 non-VAD infections. The overall rate of VAD infections (specific + related) was 8/1,000 days of VAD support. The most common pathogens were Staphylococcus aureus, coagulase-negative staphylococci, Pseudomonas aeruginosa, and Candida spp. Of 8 deaths that occurred during VAD support, 3 (37.5%) were directly related to infections. Continuous-flow VAD (p = 0.0427) and prior cardiac transplantation with rejection (p = 0.0191) were significantly associated with development of VAD infections. Infectious complications are common in pediatric patients undergoing VAD support. VAD infections do not prevent successful cardiac transplantation in children.