Longitudinal Risk Factors for Driveline Infection in Destination Therapy Patients with Left Ventricular Assist Device Support

Abstract

<h3>Purpose</h3> Continuous flow left ventricular assist device (CF-LVAD) support has been increasingly utilized as destination therapy (DT) in recent years. There has been limited focus in the literature on DT cohorts, who are at the highest longitudinal risk for complications. This study examined competing risks to driveline infection inpatients implanted with CF-LVAD as DT. <h3>Methods</h3> All patients implanted with CF-LVAD as DT at our institution between June 2008 and April 2020 were retrospectively reviewed. Data were obtained from our institutional STS and INTERMACS databases and verified by chart review. A competing risks model was applied to evaluate longitudinal driveline infection rates. Fine-Gray regression was used to evaluate thirty risk factors for driveline infection. <h3>Results</h3> Patients implanted with CF-LVAD (n=318) were classified into HeartMate II (n=205), HeartMate III (n=71),and HVAD groups (n=42). By one and three years, 21% and 37% of patients were estimated to have developed a driveline infection, respectively(Figure). Infections were classified as gram positive (67/118, 57%), gram negative (18/118, 15%), or polymicrobial (33/118, 28%). Fifteen patients (13%) developed sepsis. Fifty-four patients (46%) underwent surgical debridement. On Fine-Gray regression, number of prior LVAD implants (subdistribution hazard ratio (SHR)1.41 (1.03, 1.92), <i>P</i><0.001), African American race (SHR 1.59(1.02, 2.48), <i>P</i>=0.042), and younger age (SHR 0.97 (0.96,0.99), <i>P</i><0.001) were associated with the development of driveline infection. <h3>Conclusion</h3> Driveline infection remains a common complication after CF-LVAD implant for DT. African American and younger patients, as well as those with prior LVAD implants should be routinely monitored. Further investigation is warranted into strategies for early detection and stage-related management for destination therapy patients. The routine use of prophylactic antibiotics should also be evaluated in these redo patients.