Drive-line infections and sepsis in patients receiving the HVAD system as a left ventricular assist device

John, Ranjit; Aaronson, Keith D.; Pae, Walter E.; Acker, Michael A.; Hathaway, David R.; Najarian, Kevin B.; Slaughter, Mark S.

doi:10.1016/j.healun.2014.05.010

Cited by 92 publications

(54 citation statements)

References 22 publications

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“…Cumulative risk of percutaneous driveline infection at 1, 3 and 5 years was 7, 20 and 29% respectively. Cumulative risk of any infection for the entire cohort was 17, 33 and 45%, at 1, 3 and 5 years [39,40 ▪▪ ].…”

Section: Burden Of Bridge To Transplant Therapymentioning

confidence: 99%

New role of ventricular assist devices as bridge to transplantation

Reineke

Mohaçsi²

2017

Current Opinion in Organ Transplantation

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Purpose of reviewProgress of ventricular assist devices (VAD) technology led to improved survival and apparently low morbidity. However, from the European perspective, updated analysis of EUROMACS reveals a somewhat less impressive picture with respect to mortality and morbidity.Recent findingsWe describe the great demand of cardiac allografts versus the lack of donors, which is larger in Europe than in the United States. Technical progress of VADs made it possible to work out a modern algorithm of bridge-to-transplant, which is tailored to the need of the particular patient. We analyze the burden of patients undergoing bridge-to-transplant therapy. They are condemned to an intermediate step, coupled with additional major surgery and potential adverse events during heart transplantation.SummaryBased on current registry data, we do have to question the increasingly popular opinion, that the concept of heart transplantation is futureless, which seems to be for someone who treats and compares both patients (VAD and heart transplantation) in daily practice, questionable. Up to now, left ventricular assist device therapy remains a bridge to a better future, which means a bridge to technical innovations or to overcome the dramatic lack of donors in Europe.

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Section: Burden Of Bridge To Transplant Therapymentioning

confidence: 99%

New role of ventricular assist devices as bridge to transplantation

Reineke

Mohaçsi²

2017

Current Opinion in Organ Transplantation

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“…Infection and sepsis contribute significantly to mortality in LVAD recipients [1,10,12,20,21]. Our results suggest that anaerobic bacteremia can be considered as an adverse prognostic factor of mortality in patients with destination LVADs.…”

Section: Discussionmentioning

confidence: 68%

“…LVAD infections are a common cause of morbidity with an estimated 1-year mortality rate of 20%. Moreover, in patients who develop an infection, mortality is 5.6 times higher [12,20,21]. Infections are also one of the leading causes of readmission in these patients [22].…”

Section: Discussionmentioning

confidence: 99%

Anaerobic Bacteremias in Left Ventricular Assist Devices and Advanced Heart Failure

Murillo-García

Galindo

Pinto

et al. 2019

Case Reports in Infectious Diseases

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Left ventricular assisted devices (LVADs) have revolutionized the treatment of advanced heart failure, providing meaningful increases in survival, functional capacity, and quality of life. There are two categories of LVADs patients: (1) bridge-to-transplant and (2) destination therapy. Advanced heart failure and destination LVADs often carry a poor prognosis. The overall 1-year mortality rate remains as high as 30%. LVAD-specific infections, LVAD-related infections, and non-LVAD-related infections represent important emerging clinical problems in this setting. With an incidence ranging from 30 to 50%, these lead to high rates of hospitalization, morbidity, and mortality. Bacteremias caused by anaerobic pathogens in patients with LVAD are underreported. Herein, we describe the microbiological findings, treatment, and clinical outcome of four patients with LVADs and advanced heart failure with anaerobic bacteremias. Fusobacterium species was the most frequent etiological agent. Most patients had a relatively favorable short-term outcome with survival rates of 100% at 30 days and of 50% at 90 days. However, due to other multiple long-term complications, overall mortality remains at 50% during the first year and increases to 75% beyond the first year. Anaerobic bacteremia sources included the oral cavity from odontogenic infections and aspiration pneumonia. Anaerobic bacteremia constitutes an unfavorable mortality prognostic factor in patients with destination LVADs. We recommend implementing preventive strategies with a comprehensive dental care evaluation in patients with LVADs and advanced heart failure.

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“…Our patient initially had an MRSA percutaneous driveline infection, and the occurrence rate for this type of infection is 14%-19% per a patient year [1,2,9]. Patients with subcutaneous driveline infections often present with localized erythema, heat, drainage, bleeding, or pain at the site, and diagnosis is confirmed by culture.…”

Section: Discussionmentioning

confidence: 80%

“…Driveline infections are the major cause of morbidity and mortality in ventricular assist device (VAD) patients [1]. Infections can remain limited to the driveline exit site, spread to the pump, or infect surrounding tissues [2].…”

Section: Introductionmentioning

confidence: 99%

Driveline Sepsis Presenting As Gout

Toms

2020

Cureus

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In patients with a history of gout, there could be a delay in diagnosis of a septic joint, which increases morbidity and mortality. The literature reports rare instances of coexistent gout and septic arthritis. We present a 64-year-old male with non-ischemic cardiomyopathy, supported by a HeartWare ventricular assist device, who developed a methicillin-resistant Staphylococcus aureus (MRSA) driveline infection four months after device implant. He achieved suppression with minocycline 100 mg by mouth twice a day for five months before presenting to the emergency room with symptoms of gout. Joint aspirate was consistent with a diagnosis of MRSA as well as gout. The patient presented with typical symptoms of a percutaneous driveline infection: soreness at the exit site, erythema, and thick, purulent drainage. Wound culture of the driveline confirmed MRSA and guided antibiotic treatment. His presentation was unusual in that sepsis was identified only after he presented with septic arthritis, which led to the collection of blood cultures. He had no fever, chills, nausea, vomiting, or hypotension. This case illustrates that unresolving gout symptoms after one treatment, in a patient with a known driveline infection, should be further evaluated for possible sepsis and septic arthritis. The patient's unusual presentation of sepsis caused difficulties in diagnosis and management. To our knowledge, this is the first reported case of a driveline infection seeding a joint and causing septic arthritis.

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Drive-line infections and sepsis in patients receiving the HVAD system as a left ventricular assist device

Cited by 92 publications

References 22 publications

New role of ventricular assist devices as bridge to transplantation

New role of ventricular assist devices as bridge to transplantation

Anaerobic Bacteremias in Left Ventricular Assist Devices and Advanced Heart Failure

Driveline Sepsis Presenting As Gout

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