Survival Impact of Bacteremia on Left Ventricular Assist Device Patients Who Have Suffered Strokes

Abstract

Strokes and infection are two potential complications in patients with left ventricular assist devices (LVADs). The combination of infection and stroke is particularly concerning for LVAD recipients and may be interrelated. We evaluated the impact of concomitant bacteremia in LVAD patients who suffered a stroke. All patients implanted with a continuous flow LVAD at our center from 2009 to 2019 who experienced a stroke post LVAD implantation were included. Stroke was defined by clinical signs of stroke and confirmed by neuroimaging. We then assessed the number of hemorrhagic (HCVA) and ischemic (ICVA) strokes. All patients with bacteremia prior to stroke were included in the analysis. Kaplan Meier survival curves were used to evaluate survival. A total of 117 LVAD patients with strokes were included, of those 62 had ICVA (53%) and 55 had HCVA (47%). Forty-three of these patients (37.6%) had an episode of bacteremia prior to their stroke, of whom 14 were in the ICVA group and 29 in the HCVA group. Figure 1 demonstrates that patients with strokes and concomitant bacteremia carry significantly increased risk of mortality over two years (p=0.046) compared to patients with strokes without bacteremia. Of the observed deaths, 8 out of 14 (57%) in the ICVA group died, while 19 of the 29 (66%) in HCVA died within a 2 year period. LVAD patients with bacteremia who have a stroke carry significantly worse 2 year survival when compared to those who do not have bacteremia at the time of their stroke. Patients with bacteremia and concomitant stroke may benefit from further investigation to create strategies to reduce the probability of subsequent mortality.