Mortality in Patients with LVAD Infections Classified According ISHLT Recommendations

L. Vargas, A. Granillo, I. De Anda-Duran, B. Trachtenberg

Research output: Contribution to journalArticle

Abstract

PURPOSE: Infection is common after LVAD implantation. Standardization of infections has been proposed by the ISHLT to facilitate reporting, diagnosis and management. This classification groups infections as VAD-specific, VAD-related and non-VAD. We sought to describe mortality in patients with infections according to the ISHLT classification. METHODS: This is a retrospective analysis of patients who received a continuous-flow LVAD from 2016-2018. Clinical and microbiological characteristics of the first episode of infection requiring hospitalization during this period were obtained. Infections were classified according to ISHLT guidelines. For non-VAD infections, only bloodstream infections with secondary source of infection were recorded. Mortality was compared between categories using chi-square. RESULTS: From a total of 127 patients, 66 had at least 1 episode of infection with hospitalization. The mean time to first infection was 219 ± 178 days. The most common type of infection was VAD-specific, from this 37.9% were driveline infections. From VAD-related the most common were bloodstream infections (19.7%). Staphylococcus species and Pseudomonas species accounted for 55.7% and 18.5% respectively. No statistically significant difference was found in mortality between ISHTL classifications, p>0.05 (Table 1). CONCLUSION: ISHLT classification can be challenging to apply. Our study showed no difference in mortality among patients with at least one episode of infection classified according to ISHLT, regardless of the location or source of infection. Studies have shown VAD-specific infected patients are at lower risk of death after an infection. However, others have included bloodstream and VAD-specific co-infection within VAD-related category; possibly accounting for the discrepancies in results. Further standardization in diagnostic testing and management will allow better evaluation of outcomes and prognosis depending on the type of LVAD infection.

ASJC Scopus subject areas

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

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