Epidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT Mechanically Assisted Circulatory Support Registry

Hannan, Margaret M.; Xie, Rongbing; Cowger, Jennifer; Schueler, Stephan; By, T. de; Dipchand, Anne I.; Chu, Vivian H.; Cantor, Ryan S.; Koval, Christine; Krabatsch, Thomas; Hayward, Christopher; Nakatani, Takeshi; Kirklin, James K.

doi:10.1016/j.healun.2019.01.007

Cited by 85 publications

(110 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionsupporting

confidence: 90%

“…Infections are the leading cause of early death after LVAD implantation and heart transplantation . The incidence of LVAD infection in the study cohort is consistent with previously reported rates of 30%‐50% . A recent meta‐analysis including 13 studies which included international cohorts of LVAD infection found a significant increase in post‐transplant mortality, with a pooled HR of 1.3 .…”

Section: Discussionsupporting

confidence: 88%

“…Left ventricular assist devices (LVAD) are increasingly being used as a bridge to heart transplantation, now employed in half of those undergoing transplant . Despite significant advances in durable mechanical support survival, infectious complications remain the most common adverse event after LVAD implantation and the leading cause of early death after heart transplantation . A recent analysis from the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (INTERMACS) global registry found that 37% of patients supported by LVAD experienced 1 or more infections during the time supported by a device .…”

Section: Introductionmentioning

confidence: 99%

“…Despite significant advances in durable mechanical support survival, infectious complications remain the most common adverse event after LVAD implantation and the leading cause of early death after heart transplantation . A recent analysis from the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (INTERMACS) global registry found that 37% of patients supported by LVAD experienced 1 or more infections during the time supported by a device . There have been inconsistent findings of transplant survival outcome in patients with a preceding LVAD infection and whether an LVAD infection predisposes future transplant infection .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Outcomes of patients with infection related to a ventricular assist device after heart transplantation

Moayedi

Multani

Bunce

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

Background: Despite significant advances in durable mechanical support survival, infectious complications remain the most common adverse event after ventricular assist device (VAD) implantation and the leading cause of early death after transplantation. In this study, we aim to describe our local infectious epidemiology and review short-term survival and infectious incidence rates in the post-transplantation period and assess risk factors for infectious episodes after transplantation. Methods: Retrospective single-center study of all consecutive adult heart transplant patients from 2008 to 2017. Survival data were estimated and summarized using the Kaplan-Meier method. We quantified and evaluated the difference in the incidence rate between patients with and without infection using a Fine-Gray model. The outcome of interest is the time to first infection diagnosis with post-transplant death as the competing event.Results: Among 278 heart transplant patients, 74 (26.5%) underwent LVAD implantation. Twenty-one patients (28.3%) developed an infection while supported by an LVAD.When compared to patients supported by an LVAD without a preceding infection, BMI was significantly greater (31.2 vs 27.8 kg/m 2 , P = .03). Median follow-up post-transplantation was 3.01 years. Significant risk factors for the competing risk regression for infection after heart transplantation include LVAD infection (HR 1.94, [95% CI] 1.11-3.39, P = .020) and recipient COPD (HR 2.14, [95% CI] 1.39-3.32, P = .001) when adjusted for recipient age, gender, hypertension, diabetes mellitus, and body mass index. Conclusions:Patients with LVAD-related infection had a significantly increased risk of infectious complications after heart transplantation. Further research on the avoidance of induction agents and reduced maintenance immunosuppression in this patient population is warranted. K E Y W O R D Santibiotic prophylaxis, antibiotic:antibacterial, heart (allograft) function/dysfunction, infectious complications

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of patients with infection related to a ventricular assist device after heart transplantation

Moayedi

Multani

Bunce

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…Non-device related infections are the largest category of MCSD infection (6). While reviewing our data, an interesting finding emerged, with respect to increased incidence of acute cholecystitis.…”

mentioning

confidence: 71%