No Association between Clinical Periodontal Conditions and Microbiological Findings on Driveline of Patients with Left-Ventricular Assist Devices (LVAD).

Gerhard Schmalz,Josephine Rast,Dirk Ziebolz,Sven-Paul Zöbisch,Jens Garbade,Mirjam Eisner,Tanja Kottmann,Christian Binner,Sandra Eifert,Justus Wagner

doi:10.3390/antibiotics10101219

Gerhard Schmalz, Josephine Rast + Show 8 more

Open Access

https://doi.org/10.3390/antibiotics10101219

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Abstract

The aim of this retrospective study was to investigate whether there would be an association between periodontal disease parameters and positive bacterial findings at the driveline of patients with a left ventricular assist device (LVAD). Patients with an LVAD, who underwent a full oral and microbiological examination between 2016 and 2018, were included. During oral examination, periodontitis severity (stage and grade) and the periodontal inflamed surface area (PISA) were evaluated. A microbiological analysis was performed from swabs of the driveline, whereby different bacterial species were cultivated and analyzed. A total of 73 patients were included in the current study. The majority of participants (80.8%) had at least one positive bacterial finding during the study period. Most patients had a periodontitis stage of III-IV (80.9%). The determined PISA of the total group was 284.78 ± 352.29 mm2. No associations were found between the periodontal disease parameters and the bacterial findings in general, the bacterial findings on the day of oral examination or the bacterial findings 12 months prior to/after the oral examination (p > 0.05). Periodontitis is not associated with cultivated microbiological findings at the driveline of patients with an LVAD and thus appears not to be a risk indicator for driveline colonization. Nevertheless, the high periodontal burden in LVAD patients underlines the need for their improved periodontal care.

Highlights

To unload the failing left ventricle during the treatment of severe heart failure (HF), left-ventricular assist devices (LVAD) are commonly used to maintain end-organ perfusion and improve functional capacity [1]
While the previous study failed to confirm a relationship between driveline infection and oral health [9], the current study failed to confirm an association between positive bacterial findings at the driveline and periodontal parameters; the patient cohort in the current study was based on the same collective of patients as the previous study [9]
The oral cavity hosts a high variety of bacteria, including other species such as Staphylococcus aureus or Pseudomonas aeruginosa, whereby the periodontal biofilm can be a source for dissemination of these bacteria [19,20]

Summary

Introduction

To unload the failing left ventricle during the treatment of severe heart failure (HF), left-ventricular assist devices (LVAD) are commonly used to maintain end-organ perfusion and improve functional capacity [1]. Surgical and medical improvements during the past decade, both the number of patients living on LVAD and their life expectancy have increased [1]. While LVAD as a life-saving therapy measure leads to an improved patient outcome, several device-specific complications can occur, including infections and coagulation-related problems such as thrombosis, bleeding or device malfunction [2]. The system contains a driveline connecting the implanted pump device to the energy and leads through the skin in a subfascial tunnel. As this is an unnatural exit site, it represents a potential risk of microbial invasion [3]. Specific surgical techniques were developed to lower the rate of infection

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Conclusion