Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation

Justin M. Schaffer, Jeremiah G. Allen, Eric S. Weiss, George J. Arnaoutakis, Nishant D. Patel, Stuart D. Russell, Ashish S. Shah, John V. Conte

Research output: Contribution to journalArticle

Abstract

Background Infection is a significant source of morbidity and mortality after left ventricular assist device (LVAD) implantation. Newer generation continuous-flow (CF) LVADs are smaller, requiring smaller pump pockets and drive-line exit sites as compared with pulsatile-flow (PF) devices. With their recent adoption, CF device patients benefit from improved provider experience in the detection and treatment of infectious complications. Given these advances in design and experience, we examined the incidence of infectious complications in patients receiving CF and PF devices. Methods We reviewed patients who received CF or PF LVADs (June 2000 to May 2009) at our institution. Incidences and timing of systemic infections (bacteremia, sepsis, severe sepsis, septic shock), device-associated infections (drive-line, LVAD pocket, sternal wound) and nondevice-associated infections (catheter-related bloodstream, pneumonia, urinary tract) were compared between devices. Primary outcomes were sepsis, severe sepsis, a composite of drive-line and LVAD pocket infection, and catheter-related bloodstream infection. Results Of 133 LVADs, 86 were CF. CF patients had lower pre-operative risk, more recent device implantation, and longer LVAD support time. Device type was highly correlated with reduced infections; however, on multivariate analysis, implantation date appeared to drive this association. KaplanMeier estimates of freedom from all primary outcomes were improved with more recent implantation (p <0.05). On multivariate analysis, implantation date was predictive of all primary outcomes except severe sepsis, for which advanced age and worse Seattle Heart Failure Model score were predictive. Conclusion In this institutional review of post-LVAD infections, a decrease in infectious complications in CF patients was likely related to increased provider experience associated with a more recent date of implantation.

Original languageEnglish (US)
Pages (from-to)164-174
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number2
DOIs
StatePublished - Feb 2011

Fingerprint

Pulsatile Flow
Heart-Assist Devices
Equipment and Supplies
Sepsis
Catheter-Related Infections
Infection
Multivariate Analysis
Incidence
Septic Shock
Bacteremia
Urinary Tract
Pneumonia
Heart Failure
Morbidity
Mortality
Wounds and Injuries

Keywords

  • heart failure
  • infectious complications
  • LVAD
  • mechanical circulatory support
  • sepsis

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Schaffer, J. M., Allen, J. G., Weiss, E. S., Arnaoutakis, G. J., Patel, N. D., Russell, S. D., ... Conte, J. V. (2011). Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation. Journal of Heart and Lung Transplantation, 30(2), 164-174. https://doi.org/10.1016/j.healun.2010.08.003

Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation. / Schaffer, Justin M.; Allen, Jeremiah G.; Weiss, Eric S.; Arnaoutakis, George J.; Patel, Nishant D.; Russell, Stuart D.; Shah, Ashish S.; Conte, John V.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 2, 02.2011, p. 164-174.

Research output: Contribution to journalArticle

Schaffer, JM, Allen, JG, Weiss, ES, Arnaoutakis, GJ, Patel, ND, Russell, SD, Shah, AS & Conte, JV 2011, 'Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation', Journal of Heart and Lung Transplantation, vol. 30, no. 2, pp. 164-174. https://doi.org/10.1016/j.healun.2010.08.003
Schaffer, Justin M. ; Allen, Jeremiah G. ; Weiss, Eric S. ; Arnaoutakis, George J. ; Patel, Nishant D. ; Russell, Stuart D. ; Shah, Ashish S. ; Conte, John V. / Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 2. pp. 164-174.
@article{59522d3c00a6472ebedcfdf3deef553b,
title = "Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation",
abstract = "Background Infection is a significant source of morbidity and mortality after left ventricular assist device (LVAD) implantation. Newer generation continuous-flow (CF) LVADs are smaller, requiring smaller pump pockets and drive-line exit sites as compared with pulsatile-flow (PF) devices. With their recent adoption, CF device patients benefit from improved provider experience in the detection and treatment of infectious complications. Given these advances in design and experience, we examined the incidence of infectious complications in patients receiving CF and PF devices. Methods We reviewed patients who received CF or PF LVADs (June 2000 to May 2009) at our institution. Incidences and timing of systemic infections (bacteremia, sepsis, severe sepsis, septic shock), device-associated infections (drive-line, LVAD pocket, sternal wound) and nondevice-associated infections (catheter-related bloodstream, pneumonia, urinary tract) were compared between devices. Primary outcomes were sepsis, severe sepsis, a composite of drive-line and LVAD pocket infection, and catheter-related bloodstream infection. Results Of 133 LVADs, 86 were CF. CF patients had lower pre-operative risk, more recent device implantation, and longer LVAD support time. Device type was highly correlated with reduced infections; however, on multivariate analysis, implantation date appeared to drive this association. KaplanMeier estimates of freedom from all primary outcomes were improved with more recent implantation (p <0.05). On multivariate analysis, implantation date was predictive of all primary outcomes except severe sepsis, for which advanced age and worse Seattle Heart Failure Model score were predictive. Conclusion In this institutional review of post-LVAD infections, a decrease in infectious complications in CF patients was likely related to increased provider experience associated with a more recent date of implantation.",
keywords = "heart failure, infectious complications, LVAD, mechanical circulatory support, sepsis",
author = "Schaffer, {Justin M.} and Allen, {Jeremiah G.} and Weiss, {Eric S.} and Arnaoutakis, {George J.} and Patel, {Nishant D.} and Russell, {Stuart D.} and Shah, {Ashish S.} and Conte, {John V.}",
year = "2011",
month = "2",
doi = "10.1016/j.healun.2010.08.003",
language = "English (US)",
volume = "30",
pages = "164--174",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Infectious complications after pulsatile-flow and continuous-flow left ventricular assist device implantation

AU - Schaffer, Justin M.

AU - Allen, Jeremiah G.

AU - Weiss, Eric S.

AU - Arnaoutakis, George J.

AU - Patel, Nishant D.

AU - Russell, Stuart D.

AU - Shah, Ashish S.

AU - Conte, John V.

PY - 2011/2

Y1 - 2011/2

N2 - Background Infection is a significant source of morbidity and mortality after left ventricular assist device (LVAD) implantation. Newer generation continuous-flow (CF) LVADs are smaller, requiring smaller pump pockets and drive-line exit sites as compared with pulsatile-flow (PF) devices. With their recent adoption, CF device patients benefit from improved provider experience in the detection and treatment of infectious complications. Given these advances in design and experience, we examined the incidence of infectious complications in patients receiving CF and PF devices. Methods We reviewed patients who received CF or PF LVADs (June 2000 to May 2009) at our institution. Incidences and timing of systemic infections (bacteremia, sepsis, severe sepsis, septic shock), device-associated infections (drive-line, LVAD pocket, sternal wound) and nondevice-associated infections (catheter-related bloodstream, pneumonia, urinary tract) were compared between devices. Primary outcomes were sepsis, severe sepsis, a composite of drive-line and LVAD pocket infection, and catheter-related bloodstream infection. Results Of 133 LVADs, 86 were CF. CF patients had lower pre-operative risk, more recent device implantation, and longer LVAD support time. Device type was highly correlated with reduced infections; however, on multivariate analysis, implantation date appeared to drive this association. KaplanMeier estimates of freedom from all primary outcomes were improved with more recent implantation (p <0.05). On multivariate analysis, implantation date was predictive of all primary outcomes except severe sepsis, for which advanced age and worse Seattle Heart Failure Model score were predictive. Conclusion In this institutional review of post-LVAD infections, a decrease in infectious complications in CF patients was likely related to increased provider experience associated with a more recent date of implantation.

AB - Background Infection is a significant source of morbidity and mortality after left ventricular assist device (LVAD) implantation. Newer generation continuous-flow (CF) LVADs are smaller, requiring smaller pump pockets and drive-line exit sites as compared with pulsatile-flow (PF) devices. With their recent adoption, CF device patients benefit from improved provider experience in the detection and treatment of infectious complications. Given these advances in design and experience, we examined the incidence of infectious complications in patients receiving CF and PF devices. Methods We reviewed patients who received CF or PF LVADs (June 2000 to May 2009) at our institution. Incidences and timing of systemic infections (bacteremia, sepsis, severe sepsis, septic shock), device-associated infections (drive-line, LVAD pocket, sternal wound) and nondevice-associated infections (catheter-related bloodstream, pneumonia, urinary tract) were compared between devices. Primary outcomes were sepsis, severe sepsis, a composite of drive-line and LVAD pocket infection, and catheter-related bloodstream infection. Results Of 133 LVADs, 86 were CF. CF patients had lower pre-operative risk, more recent device implantation, and longer LVAD support time. Device type was highly correlated with reduced infections; however, on multivariate analysis, implantation date appeared to drive this association. KaplanMeier estimates of freedom from all primary outcomes were improved with more recent implantation (p <0.05). On multivariate analysis, implantation date was predictive of all primary outcomes except severe sepsis, for which advanced age and worse Seattle Heart Failure Model score were predictive. Conclusion In this institutional review of post-LVAD infections, a decrease in infectious complications in CF patients was likely related to increased provider experience associated with a more recent date of implantation.

KW - heart failure

KW - infectious complications

KW - LVAD

KW - mechanical circulatory support

KW - sepsis

UR - http://www.scopus.com/inward/record.url?scp=78650948706&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650948706&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2010.08.003

DO - 10.1016/j.healun.2010.08.003

M3 - Article

VL - 30

SP - 164

EP - 174

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 2

ER -