Introduction Device infection remains a significant cause of morbidity and mortality in patients supported by mechanical assist devices. The infection.

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Presentation transcript:

Introduction Device infection remains a significant cause of morbidity and mortality in patients supported by mechanical assist devices. The infection may involve the percutaneous driveline, device pocket, or the internal components of the device itself. Risk factors for the development of infection post-LVAD have yet to be well defined. This study evaluated pre-operative risk factors for LVAD-related infection in patients undergoing HeartMate II(HMII) LVAD as destination therapy. Materials and Methods Pre-operative demographics, BMI, and laboratory tests were compared between 41 patients receiving HMII as destination therapy. Comparisons were made between those who developed infections and those who did not. (Table 1) All infections occurred at least 30 days after implantation. Average time to infection was 309 days. Average length of follow up for those who remained infection free was days. All patients had at least 6 months of follow up from time of implantation. Conclusions and Recommendations Hyponatremia and liver dysfunction are indicators of advanced left and right ventricular dysfunction. These indices were significantly associated with the development of LVAD infection suggesting that LVAD patients who develop infection have more advanced heart failure prior to implantation. Lymphocytopenia has been noted to be an important prognostic factor in heart failure. Absolute lymphocyte count was significantly lower in patients developing LVAD infection suggesting that severity of heart failure as well as nutritional and immunologic status may contribute to LVAD infection. Preoperative Risk Factors for Left Ventricular Assist Device Related Infection. Sunil Pauwaa, MD, Christopher Blair, Pooja Avula, Parin Mehta, Antone J Tatooles, MD, and Geetha Bhat, PhD, MD. Center for Heart Transplant and Assist Devices, Advocate Christ Medical Center, Oak Lawn, IL, United States, Abstract Preoperative Risk Factors for Left Ventricular Assist Device Related Infection. Sunil Pauwaa, MD, Christopher Blair, Pooja Avula, Parin Mehta, Antone J Tatooles, MD, and Geetha Bhat, PhD, MD. Purpose: Infection represents a serious complication after left ventricular assist device (LVAD) implantation. This study evaluated risk factors for LVAD-related infection in patients undergoing HeartMate II LVAD as destination therapy. Methods and Materials: Pre-operative laboratory tests were compared between LVAD patients who developed infections and those who did not. (Table 1) All patients had at least 6 months of follow up from time of implantation. Results: 17/41 (41%) patients developed a total of 24 LVAD related infections (1 sternal, 8 pocket, and 15 percutaneous driveline). Absolute lymphocyte count and sodium were significantly lower in patients who developed infection while alkaline phosphatase and total bilirubin were significantly higher. Conclusions: LVAD patients who develop infection appear to have more advanced heart failure as reflected by liver dysfunction, decreased sodium and lower absolute lymphocyte count. Heart failure combined with metabolic and immunologic factors may play a role in LVAD related infections. Comparison of Infected and Non-Infected HMII Patients Infected (n=17) Non-infected (n=24) p-value Age60.3± ± BMI (kg/m )29.02 ± ± White Blood Cell Count (thousand/mcL)7.89 ± ± Lymphocyte Percentage (%)15.63 ± ± Absolute Lymphocyte Count (thousand/mcL)1.09 ± ±1.7.05* Sodium (mmol/L)132.65± ± * Albumin (gm/dL)3.08 ± ± PreAlbumin (mg/dL)17.53 ± ± Cholesterol (mg/dL) ± ± Total Protein (mg/dL)6.62 ± ± BUN (mg/dL)31.88 ± ± Creatinine (mg/dL)1.67 ± ± ALT (unit/L)43.65 ± ± AST (unit/L)23.12 ± ± Total Bilirubin (mg/dL)1.72 ± ±.7.05* Alkaline Phosphatase (unit/L)98.71 ± ± * Hemoglobin (gm/dL)11.82 ± ± Platelets (thousand/mcL) ± ± BNP (pg/ml) ± ± Results 17/41 (41%) patients developed a total of 24 LVAD related infections (1 sternal, 8 pocket, and 15 percutaneous driveline). Absolute lymphocyte count and plasma sodium were significantly lower in patients who developed infection while alkaline phosphatase and total bilirubin were significantly higher. A higher BMI and hemoglobin level as well as a lower total cholesterol level all showed a trend toward significance in predicting the development of infection. Table 1 Infected (n=17)Non-infected (n=24)p-value Age BMI (kg/m ) White Blood Cell Count (thousand/mcL) Lymphocyte Percentage (%) Absolute Lymphocyte Count (thousand/mcL) Sodium (mmol/L) Albumin (gm/dL) PreAlbumin (mg/dL) Cholesterol (mg/dL) Total Protein (mg/dL) BUN (mg/dL) Creatinine (mg/dL) ALT (unit/L) AST (unit/L) Total Bilirubin (mg/dL) Alkaline Phosphatase (unit/L) Hemoglobin (gm/dL) Platelets (thousand/mcL) BNP (pg/ml)