Driveline Infection Research Articles

314 Radiographic Risk Factors for Intracranial Hemorrhage in Patients with Left Ventricular Assist Devices

INTRODUCTION: Intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVAD) is a complication with significant morbidity and mortality. Many studies have identified demographic risk factors for ICH in LVAD patients; however, anatomic pre-disposition to ICH in these patients has not yet been investigated. METHODS: We reviewed 440 patients who received an LVAD at our institution. We then selected patients who received CT scans of the head for any reason near the time of LVAD placement. 288 patients (21 ICH, 278 Control) with CT scans were included in the analysis. A detailed chart review was then performed to collect data on patient demographics, radiographic findings, and complications. RESULTS: The incidence of ICH in our complete cohort was 8.6% (38/440). The presence of pump thrombosis (p = 0.001), driveline infection (p = 0.034), other hemorrhage (p = 0.001), or previous placement of a cardio-defibrillator (p = .003) during the period of LVAD implantation was associated with increased risk for ICH. An analysis of patient imaging revealed that the presence of a mass (p = 0.006), vascular malformation (p = 0.001), and microangiopathy (p = 0.04) was significantly associated with ICH in LVAD patients. We further validated the significance of these radiographic features using a multivariate logistic regression which showed that the presence of a mass (aOR 332.1, 95% CI: 14.7-7485.1, p < 0.001), vascular malformation (aOR 69.7, 95% CI: 1.8-2658.8, p = 0.022), and microangiopathy (aOR 6.5, 95% CI: 1.1-37.6, p = 0.035) were independently associated with ICH. CONCLUSIONS: Radiographic evidence of microangiopathy, intracranial mass, and vascular malformation are independent risk factors for ICH which may be identified at or before the time of LVAD implantation. We advocate that CT imaging may be used to further stratify patients at highest risk of ICH during treatment with an LVAD.

(269) Treatment Concept of Chronic Ventricular Assist Device Driveline Infections with Vacuum Assisted Closure Therapy as Bridge to Transplant Strategy

(269) Treatment Concept of Chronic Ventricular Assist Device Driveline Infections with Vacuum Assisted Closure Therapy as Bridge to Transplant Strategy

(268) Prevention of Driveline Infections with Cold Atmospheric Argon Plasma: A Randomized Trial Comparing Two Surgical Techniques

(268) Prevention of Driveline Infections with Cold Atmospheric Argon Plasma: A Randomized Trial Comparing Two Surgical Techniques

Vitamin D deficiency and driveline infection in patients with a left ventricular assist device implant

Driveline infection is a frequent complication in recipients of durable left ventricular assist devices (LVAD), but its cause is largely unclear. Since vitamin D supplementation can reduce the risk of infections, we aimed at investigating the association of vitamin D deficiency with driveline infection. In 154 patients with continuous flow LVAD implants, we assessed 2-year risk of driveline infection according to vitamin D status (circulating 25-hydroxyvitamin D < 25 nmol/L or ⩾25 nmol/L). Of the study cohort, 34% (n = 53) had 25-hydroxyvitamin D concentrations <25 nmol/L. Kaplan-Meir estimates of 2-year freedom from driveline infection were in the vitamin D deficient and vitamin D non-deficient groups 49.7% and 74.2%, respectively (p = 0.017). Covariate-adjusted hazard ratio of driveline infection for the vitamin D deficient versus non-deficient group was 2.51 [95% CI: 1.11-5.69; p = 0.028). Circulating concentrations of endocrine regulators of calcium and phosphorus metabolism such as parathyroid hormone, 1,25-dihydroxyvitamin D, and fibroblast growth factor-23 were not significantly associated with the risk of driveline infection (p-values > 0.15). In total, our data indicate that in LVAD recipients deficient vitamin D status is a predictor of driveline infection, but future studies are needed to investigate whether these associations are causal.

The Evolution of Durable, Implantable Axial-Flow Rotary Blood Pumps

Left ventricular assist devices (LVADs) are increasingly used to treat patients with end-stage heart failure. Implantable LVADs were initially developed in the 1960s and 1970s. Because of technological constraints, early LVADs had limited durability (eg, membrane or valve failure) and poor biocompatibility (eg, driveline infections and high rates of hemolysis caused by high shear rates). As the technology has improved over the past 50 years, contemporary rotary LVADs have become smaller, more durable, and less likely to result in infection. A better understanding of hemodynamics and end-organ perfusion also has driven research into the enhanced functionality of rotary LVADs. This paper reviews from a historical perspective some of the most influential axial-flow rotary blood pumps to date, from benchtop conception to clinical implementation. The history of mechanical circulatory support devices includes improvements related to the mechanical, anatomical, and physiologic aspects of these devices. In addition, areas for further improvement are discussed, as are important future directions-such as the development of miniature and partial-support LVADs, which are less invasive because of their compact size. The ongoing development and optimization of these pumps may increase long-term LVAD use and promote early intervention in the treatment of patients with heart failure.

Diversity and dynamics of clinical biofilms in ventricular assist device driveline infections and in vitro modelling

The important role of microbial biofilms in medical device-related infections is well established. Intervention strategies developed from in vitro biofilm studies often fail to prevent or cure device-related infections, possibly due to limited relevance of the simplified in vitro biofilm models to the much more complex clinical reality. It is important to use in vitro biofilm assays that closely mimic the dynamically changing clinical environment. This review uses ventricular assistant device driveline infections as a model of disease to demonstrate the morphological diversity and dynamics of clinical biofilms that are important for disease pathogenesis. We also provide insights into how to develop in vitro assays to address the complexity of device-related infections, focusing on pathogen-device interactions, infectious microenvironment, and selection of representative microorganisms and biomaterials.

Added value of semi-quantitative analysis of [18F]FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device.

Left ventricular assist devices (LVADs) improve quality of life and survival in patients with advanced heart failure, but device-related infections (DRIs) remain cumbersome. We evaluated the diagnostic capability of [18F]FDG PET/CT, factors affecting its accuracy, and the additive value of semi-quantitative analysis for the diagnosis of DRI. LVAD recipients undergoing [18F]FDG PET/CT between 2012 and 2020 for suspected DRI were retrospectively included. [18F]FDG PET/CT was performed and evaluated in accordance with EANM guidelines. The final diagnosis of DRI, based on multidisciplinary consensus and findings during surgery, whenever performed, was used as the reference for diagnosis. 41 patients were evaluated for 59 episodes of suspected DRI. The clinical evaluation established driveline infection in 32 (55%) episodes, central device infection in 6 (11%), and combined infection in 2 (4%). Visual analysis of [18F]FDG PET/CT achieved a sensitivity and specificity for driveline infections of 0.79 and 0.71, respectively, whereas semi-quantitative analysis achieved a sensitivity and specificity of 0.94 and 0.83, respectively. For central device component infection, visual analysis of [18F]FDG PET/CT achieved a sensitivity and specificity of 0.75 and 0.60, respectively. Semi-quantitative analysis using SUVratio achieved a sensitivity and specificity of 1.0 and 0.8, respectively. The increase of specificity for central component infection was statistically significant (P = 0.05). [18F]FDG PET/CT reliably predicts the presence of DRI in LVAD recipients. Semi-quantitative analysis may increase the specificity of [18F]FDG PET/CT for the analysis of central device component infection and should be considered in equivocal cases after visual analysis.

2025. Outcomes of Pseudomonas aeruginosa Ventricular Assist Device Infection

Abstract Background Ventricular assist device (VAD) infections caused Pseudomonas aeruginosa (PA) are difficult to treat given limited antibiotic options, development of resistance and biofilm formation in the presence of retained hardware. We looked at outcomes of patients who developed Pseudomonas aeruginosa LVAD infection (PA-LVADI) Methods Single center retrospective study of patients older than 18 years who received LVAD from 7/1/2007 to 2/1/2021 and subsequently developed PA-LVADI. Patients with proven or probable VAD-specific infections: driveline infection (DLI), pump pocket, and pump/cannula infections were included. The cumulative incidences of death, transplant, and LVAD explant, following Pseudomonas aeruginosa infection, were evaluated as competing outcomes. Fig 1:Classification of Pseudomonas aeruginosa LVAD Infections at diagnosisFigure 3:Cumulative incidence of death, transplant, or explant following Pseudomonas aeruginosa LVAD infection Results 51 patients with VAD-specific PA-LVADI were identified (Fig 1). Median age at the time of first LVAD placement was 55 years (23 – 74). Of the 28 patients ever listed for transplant, 13 (46%) received heart transplant, 8 (29%) were delisted, 7 (25%) were alive on transplant list (Fig 2). The median number of days from LVAD placement to first PA infection was 587 (54 – 3389). 30 (59%) had PA as the first causative organism. The extent of first PA-LVADI was superficial DLI in 43(84%), deep DLI in 5 (10%), pump pocket in 2(4%) and pump/cannula in 1(2%). 46 (90%) of patients received intravenous (IV) therapy with median duration of 84 (2 – 525) total IV antibiotic days. Antibiotic resistance emerged in 25/51 (49%) patients, with 32% being multi-drug resistant (MDR). Surgery was performed in 30 (58%). 12/13 who received heart transplants were followed for at least 1 year post-transplant and all were alive. 5 of the remaining 38 patients underwent pump exchange or explant. 20/38 (53%) of patients who were not transplanted died (Fig 3). Conclusion This is the largest study on PA-LVADI to date. We noted significant morbidity and mortality, with 90% of patients requiring prolonged IV antibiotics and over half requiring surgical treatment. Drug resistance emerged in a significant proportion of patients. Survival after transplant was excellent, but by 2 years of infection over half of the patients have been transplanted, explanted, or died. Disclosures All Authors: No reported disclosures.

1859. Significance of Bacteremia in Left Ventricular Assist Device Infections due to Pseudomonas aeruginosa

Abstract Background Infection is one of the most common complications of Left Ventricular Assist Devices (LVADs). Pseudomonas aeruginosa (PsA) LVAD infections in particular are challenging due to limited antibiotic options and tendency to form biofilm making eradication difficult. In this study we examined the implications of bacteremia in patients with PsA LVAD infections. Methods This was a retrospective study of patients treated at our institution between July 1, 2007 and February 1, 2021 who had proven or probable driveline infection (DLI), pump pocket, or pump/cannula infection due to PsA according to International Society for Heart &amp; Lung Transplantation criteria. Results Of 717 patients with an LVAD, 51 patients had had proven or probable VAD-specific infections due to PsA.16/51 (31%) had Pseudomonas bloodstream infection associated with the VAD infection, with a median 400 days from initial diagnosis. Only 29% of those with DLI were bacteremic, vs. 66% of those with pump pocket infection, and 50% of those with mediastinitis (Fig 1). Patients who developed bacteremia had a median of 3 episodes (range, 1-5). All but 1 patient with bacteremia received surgery. Of the 16 patients who developed bacteremia, 11 (69%) died vs 9/35 (26%) in patients who were not bacteremic (Fig 2). 10/11 patients who were bacteremic and died had infections limited to driveline. In 21/41 (51%) of episodes of bacteremia identified, patients were already on antibiotics for PsA with a median duration of 49 days (7-198) prior to onset of bacteremia. Conclusion A significant number of patients with PsA LVAD infections develop bacteremia, especially in those with involvement of central LVAD components. The presence of bacteremia should prompt evaluation for ascending infection. Most of the patients who developed bacteremia died, even when infection appeared limited to driveline, and it is possible that endoluminal infections were present in these cases. A substantial proportion of patients with bacteremia were on antibiotics at the time of bacteremia, which suggests that suppressive antibiotics alone may not be effective in controlling PsA LVAD infections. Disclosures All Authors: No reported disclosures.

2021. Efficacy of Chronic Antimicrobial Suppressive Therapy in Ventricular Assist Device Infections

Abstract Background Ventricular assist devices (VAD) prolong life expectancy or serve as a bridge to heart transplant in end stage heart failure but are not without risks. These patients are at high risk for device-related infections with a propensity for relapse. Indications and efficacy of chronic antimicrobial suppression (CAS) to prevent relapse are not well defined. Methods We conducted a retrospective study of all adult patients with VAD infections at our institution between 1/1/2013 and 10/31/2020. VAD-specific or VAD-related infections were defined by the International Society for Heart and Lung Transplantation criteria. Patients were stratified by receipt of CAS or no CAS after completing index infection treatment. Relapsed infections were defined as those recurred at the same site caused by the same organism seen in the index infection. Time-to-relapse infection was defined as the time in days between the index infection and first relapse. The primary outcome was CAS efficacy measured by time-to-relapse in VAD-specific or -related infections. Results A total of 83 patients were included with a documented VAD-specific (n = 68) or VAD-related (n = 15) infection. Driveline (n = 66) and bloodstream (n = 13) infections were the most common VAD-specific and VAD-related infections, respectively. For the index infection, all patients received antimicrobial treatment and 16.4% required incision and drainage. Staphylococcus aureus was most frequently isolated in 46 cases. Oral minocycline was the most commonly utilized agent in 22 of 47 patients receiving CAS. Agent-specific CAS efficacy was unable to be assessed due to the small sample. In patients who received CAS, 57% experienced a relapse infection compared to 81% in patients not receiving CAS (p = 0.03). The median time to relapse was 151 days (IQR 78-247) and 57 days (IQR 36-114) in the CAS and non-CAS groups, respectively (p &amp;lt; 0.01). Conclusion The incidence of relapse infection in the setting of CAS was lower compared to those not receiving CAS. Patients receiving CAS were relapse-free for a significantly longer duration. Larger studies are warranted to assess if one agent confers a benefit over another. Disclosures M. Rizwan Sohail, MD, Aziyo Biologics: Honoraria|Boston Scientific Corporation: Honoraria|Medtronic: Grant/Research Support|TRYX: Grant/Research Support.

Delayed versus primary sternal closure for left ventricular assist device implantation: Impact on mechanical circulatory support infections

Delayed sternal closure may be required after left ventricular assist device (LVAD) implantation due to coagulopathy or hemodynamic instability. There is conflicting data regarding infection risk. We performed a single-center, retrospective analysis of patients who received their first LVAD between May 2012 and January 2021. Patients were divided into delayed sternal closure (DSC) and primary sternal closure (PSC) groups. We used chi-squared or Fisher Exact tests, as appropriate, to compare the incidence of postoperative LVAD-related infections (mediastinal/sternal wound) and LVAD-specific infections (driveline and pump pocket) after definitive chest closure between these two groups. A total of 327 patients met eligibility criteria, including 127 (39%) patients that underwent DSC and 200 (61%) patients that had a PSC. Demographic and clinical characteristics were similar except for an overrepresentation of men (87% vs. 75%, p=.016), Interagency Registry of Mechanically Assisted Circulatory Support class I-II patients (89% vs 66%, p < .001), patients with a previous sternotomy (43% vs 13%, p < .001), and patients with chronic kidney disease (55% vs 43%, p=.030) in the DSC group. The median DSC time was 24 (IQR: 24-48) hours. The incidence of LVAD-related mediastinal/sternal wound infection was similar between the DSC and PSC groups (4.7% vs 3.0%, p=.419). There was no difference between DSC and PSC groups in the incidence of driveline infection (6.3% vs 9%, p=.411) and pump pocket infection (1.6% vs 1.5%, p =.901), respectively. DSC does not seem to increase the incidence of LVAD-related or LVAD-specific infection rates in heart failure patients undergoing device implantation surgery.

Hyperpolypharmacy is a predictor of mortality after left ventricular assist device (LVAD) implantation

BackgroundThe prevalence of (hyper)polypharmacy in patients on left ventricular assist device (LVAD) support and its effect on clinical outcomeis unknown. Therefore, we aimed to determine the prevalence of (hyper)polypharmacy in LVAD patients and evaluate its association with mortality and complications. Materials and methods210 patients aged ≥40 years who received a primary LVAD implantation between 2011 and 2019 were included for analysis. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of 5–9 and ≥10 medications at discharge after LVAD implantation, respectively. Cause specific cox regression was used to assess the association of ≥10 medications with mortality, cardiac arrhythmia, driveline infection and major bleeding. ResultsThe median age of the patients was 57.5 years, and 35.7 % were female. The average number of discharge medications was 8.8 ± 2.3 per patient. The prevalence of patients with 5–9 medications and ≥10 medications was 62.9 % and 34.8 %, respectively. The median follow-up duration was 948 days (interquartile range 874 days). The prescription of ≥10 medications was significantly associated with a higher risk of mortality (HR 2.03; 95 % CI 1.15–3.6, p-value 0.02) adjusted for sex, age, comorbidity and stratified for device type. The prescription of ≥10 medications was not associated with a higher risk of major bleeding, cardiac arrhythmia or driveline infection. Conclusions(Hyper)polypharmacy is highly prevalent in LVAD patients and is independently associated with a higher risk of mortality. Future research is needed to assess the efficacy of individual risk-benefit profiling of (cardiovascular) medication to ensure appropriate polypharmacy and to decrease negative health outcomes.

Impact of Fried Frailty Phenotype on Postoperative Outcomes After Durable Contemporary Mechanical Circulatory Support: A Single-Center Experience.

Frailty is prevalent in advanced heart failure patients and may help distinguish patients at risk of worse outcomes. However, the effect of frailty on postoperative clinical outcomes is still understudied. Therefore, we aim to study the relationship between frailty and postoperative clinical outcomes in patients undergoing long-term mechanical circulatory support (MCS). Forty-six patients undergoing durable MCS (left ventricular assist device and total artificial heart) placement at our medical center were assessed for frailty pre-implant. Frailty was defined as ≥ 3 physical components of the Fried frailty phenotype. Our primary endpoint is 1 year of survival post-implant. Secondary endpoints include 30-day all-cause rehospitalization, pump thrombosis, neurological event (stroke/transient ischemic attack), gastrointestinal bleeding, and driveline infection within 12 months post-MCS support. Of the 46 patients, 32 (69%) met the criteria for frailty according to Fried. The cohort's median age was 67.0 years. The frail group had statistically significant lower left ventricular ejection fraction (LVEF) (11% vs. 20%, P = 0.017) and lower albumin (3.5 vs. 4.0 g/dL, P = 0.021). The frail cohort also had significantly higher rates of comorbid chronic kidney disease (47% vs. 7%, P = 0.016). There were no differences between the frail vs. non-frail group in terms of 30-day readmission rates (40% vs. 39%, P = 0.927) and 1-year post-intervention survival (log-rank, P = 0.165). None of the other secondary endpoints reached statistical significance, although the incidence of gastrointestinal bleed (24% vs. 16%, P = 0.689) and pump thrombosis (8% vs. 0%, P = 0.538) were higher in the frail group. Preoperative Fried frailty was not associated with readmission at 30 days, mortality at 365 days, and other postoperative outcomes in long-term durable MCS patients. Findings may need further validation in larger studies.

Effect of Diabetes Mellitus on Outcomes in Patients With Left Ventricular Assist Device - Analysis of Data From a Japanese National Database.

The objective of this study is to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with continuous-flow left ventricular assist device (LVAD) by using data from a national database. The 545 study patients who underwent primary HeartMateII implantation between 2013 and 2019 were divided into 2 groups according to their diabetes mellitus (DM) status; patients with DM (n=116) and patients without DM (n=429). First, the on-device survival and incidence of adverse events were evaluated. Second, after adjusting for patients' backgrounds, the change of laboratory data in the 2 groups were compared. Overall, on-device survival at 1, 2, and 3 years was almost equivalent between the 2 groups; it was 95%, 94%, and 91% in patients without DM, and 93%, 91%m and 91% in patients with DM (P=0.468) The incidence of adverse events was similar between 2 groups of patients, except for driveline exit site infection in the adjusted cohort. Cox proportional hazards regression analysis revealed younger age (HR: 0.98 (95% confidence interval (CI): 0.97-0.99, P=0.001) and presence of DM (HR: 1.83 (95% CI: 1.14-2.88), P=0.016) as significant predictors of driveline infection. Laboratory findings revealed no differences between groups throughout the periods. The clinical results after LVAD implantation in DM patients were comparable with those in non-DM patients, except for the driveline exit site infection.

New Wound Management of Driveline Infections with Cold Atmospheric Plasma.

The use of ventricular assist devices as a bridge to transplant or as destination therapy has increased. Wound complications increase morbidity in this cohort. Cold atmospheric plasma is a source of reactive oxygen and nitrogen species and can reduce the microbial load in skin wounds without negative effects on the surrounding tissue. We evaluated our cold atmospheric plasma treatment for LVAD driveline infections in a retrospective single-center study for peri- and postintervention outcome analysis. Between April 2019 and September 2019, 15 male patients were included (5 HVAD, 10 HeartMate III). The wounds were treated for a mean of 368.5 s with a reduction of bacterial load in treated wounds in 60% of patients, regardless of the pathogen. The most common pathogen was staphylococcus aureus (n = 8 patients). There was a significant reduction of the wound scale (scale 2.80 vs. 1.18; p < 0.001) plus a significant reduction in size (16.08 vs. 1.90 cm3; p = 0.047). Seven patients (46.6%) were free from any signs of local or systemic infection during 1-year follow-up. Five patients (33%) received a heart transplantation. Cold atmospheric plasma treatment is a potent, safe, and painless adjuvant technique for treating driveline infection without the need for repeating surgical interventions.

Driveline Infections Associated With Durable Left Ventricular Assist Device Support: An Ounce of Prevention is Worth a Pound of Cure.

Driveline Infections Associated With Durable Left Ventricular Assist Device Support: An Ounce of Prevention is Worth a Pound of Cure.

Prophylactic negative pressure wound therapy is not effective for preventing driveline infection following left ventricular assist device implantation.

Driveline infection (DLI) following left ventricular assist device (LVAD) implantation remains an unresolved problem. Negative pressure wound therapy (NPWT) promotes wound healing by applying negative pressure on the surface of the wound. Recently, the prophylactic application of NPWT to closed surgical incisions has decreased surgical site infections in various postsurgical settings. Therefore, we evaluated the efficacy and safety of prophylactic NPWT for preventing DLI in patients with LVAD implantation. Prophylactic NPWT was provided to 50 patients who received continuous-flow LVADs as bridge-to-transplant therapy at our institution between May 2018 and October 2020 (NPWT group). The negative pressure dressing was applied immediately after surgery and retained on the driveline exit site for 7 days with a continuous application of -125 mm Hg negative pressure. The primary outcome was DLI within 1 year of LVAD implantation. We compared the rate of DLI incidence in the NPWT group with that in the historical control cohort (50 patients) treated with the standard dressing (SD) who received LVAD implantation between July 2015 and April 2018 (SD group). No severe complications were associated with the NPWT. During the follow-up period, DLI was diagnosed in 16 participants (32%) in the NPWT group and 21 participants (42%) in the SD group. The rates of DLI incidence and freedom from DLI did not differ between groups (p=0.30 and p=0.63). Prophylactic NPWT at the driveline exit site was safe following LVAD implantation. However, it did not significantly reduce the risk of DLI.

Abstract 14742: Driveline Infections Are Associated With Increased Hospitalizations Amongst Heartmate III Recipients

Introduction: The Heartmate III (Abbott, Chicago) is the only currently available durable left ventricular assist device (LVAD). Driveline infections (DLI) are a potential complication of durable mechanical circulatory support (MCS). We sought to analyze the impact of driveline infections on post-implantation outcomes. Methods: Consecutive patients who underwent implantation of a Heartmate III LVAD at our institution were analyzed. Patients were excluded if the device was placed as part of an exchange for another durable MCS device. Patients were followed until transplant, device exchange, death, or end of follow up. The primary outcome was the difference in number of hospitalizations and days hospitalized between patients with driveline infections compared to those without. Results: 130 patients (average age 59 years, 71% male) underwent implantation of a Heartmate III LVAD between September 2015 and March 2021. Over an average follow up of 23 months, 51 patients developed a documented DLI. The average time to DLI was 336 days. 90 percent of the initial DLI were caused by single organisms and 53 percent of these organisms were gram-positive. The number of total hospitalizations (2.6 vs. 5.9, p=0.00001) and total days hospitalized (28.8 vs. 62.7, p=0.0002) were increased in patients with DLI. Patients with DLI spent an average of 27 days hospitalized for reasons related to their DLI. 23 percent of patients with DLI required extended treatment with IV antibiotics for their first infection. 31 percent of patients with DLI were later transitioned from oral to extended treatment with intravenous antibiotics. 16 patients with DLI required debridement and 5 ultimately required device exchange. Conclusions: Despite improvement in device design and hemocompatibility, driveline infections remain a common source of morbidity for patients supported by Heartmate 3 LVAD and are associated with increased hospitalizations and hospitalization days. The potential morbidity should be discussed with patients prior to implantation and diligent care must be taken post-implantation to reduce the impact of this common complication.

Abstract 10230: Epidemiology of Early and Late Ventricular Assist Device Infections in Bridge-to-Transplant Patients: A Single Centre Experience

Introduction: Bacterial infections are common after ventricular assist device (VAD) implantation. Better understanding of their epidemiology in bridge-to-transplant (BTT) pts will allow for improved infection prevention, management, and optimization for transplantation. Methods: We performed a retrospective cohort study of 42 BTT pts with VAD infections from 4/2006-10/2020. VAD-specific and VAD-related infections were characterized according to 2011 ISHLT definitions. Infections were classified as early if occurring ≤ 90 days, and late if occurring &gt;90 days after VAD implantation. Results: The prevalence of VAD infections among BTT pts was 23%, with 24% of those occurring early and 76% occurring late. Pts with infections were predominantly male (n=32, 76%) and white (n=30, 71%), with non-ischemic cardiomyopathy (n=22, 52%), and mean age at implantation of 52.7y. There were no significant differences in baseline characteristics between pts who developed early or late VAD infections (Table 1). Pts had VAD infections involving the bloodstream (n=22), driveline (n=22), pump (n=9), and pocket (n=3), with an additional 10 pts with possible endocarditis and 3 with sternal infections/mediastinitis. Most superficial driveline infections occurred more than 90 days after implantation (19 vs. 1, p=0.029). There were no significant differences in the incidence of early and late infection for the remainder of VAD-related infections reviewed (Table 2). Gram-negative organisms were responsible for the most infections (n=15), followed closely by Staphylococcus aureus (n=14); there was no significant difference in organisms causing early vs. late infection (Table 3). Conclusions: In this single center study of BTT pts over a 14-year period, superficial drive-line infections rarely occurred in the first 90 days post-VAD implantation. Gram-negative rods and Staphylococcus aureus were nearly equally responsible for most infections.

Impact of an improved driveline management for HeartMate II and HeartMate 3 left ventricular assist devices.

We evaluated the impact of a standardized driveline care strategy, including a subfascial-tunneling method and dressing protocol, on the incidence of driveline infection (DLI). DLI data from all HeartMate II (HMII) and HeartMate 3 (HM3) patients (including exchange devices) were retrospectively collected between 2013 and 2021. The driveline subfascial-tunneling method was altered in three steps (A: right direct; B: left triple, C: right triple), and the shower protocol was changed in two steps (A: with/without cover, B: with cover). Disinfection was individually tailored after changing the shower protocol. Complications associated with morbidity and mortality were evaluated for each modification. During the study period, 80 devices were implanted (HMII, n=54; HM3, n=26). The 8-year incidence of DLI was 15% (n=8) in HMII patients and 0% in HM3 patients (p=0.039). DLI was not associated with hospital mortality. The modified dressing protocol and tunneling method was associated with a significantly better DLI incidence rate in comparison to the previous one: Protocol-A (n=17), Protocol-B (n=63), 35% vs 3% (p=0.0009), Method-A (n=13), Method-B (n=42), Method-C (n=25), 46% vs 5% vs 0% (p=0.0001). The rete of freedom form DLI at 1, 2, and 3 years had also significant difference between groups: Protocol-A and Protocol-B, 80%, 54%, 54% vs 96%, 96%, 96%, respectively (p < 0.0001), Method-A, Method-B and Method-C, 76%, 44%, 44%, vs 94%, 94%, 94% vs 100%, 100%, respectively (p < 0.0001). A standardized triple driveline tunneling strategy and waterproof dressing protocol reduced driveline infection in HM3 patients to 0%.