Left ventricular assist device infection is associated with increased mortality but is not a contraindication to transplantation.
BACKGROUND
Left ventricular assist devices (LVADs) are increasingly used as a bridge to transplantation. Infection is a frequent and major complication associated with the use of these devices, however, the correlation of infection and outcome has not yet been evaluated in a prospective fashion.


RESULTS
Twenty-five patients (24 male, 1 female) with end-stage cardiac failure and resulting organ dysfunction were included. Patients were bridged with the Novacor N100 portable LVAD (median duration of support, 55 days) and were evaluated prospectively by device surface cultures on explantation, molecular typing of isolates, and correlation of infection with survival to transplant. Twelve (48%) of 25 patients had LVAD infection as defined by recovery of multiple isolates of identical genotype from the device surface. Whereas only 5 (42%) of 12 patients with LVAD infection survived until transplantation, 11 (85%) of 13 patients without infection were successfully transplanted (P < .05). Death of the 7 patients with proven LVAD infection was associated with multiple organ failure or other signs of acute infection.


CONCLUSIONS
LVAD infection is associated with a significantly decreased survival probability. It does not preclude successful bridging but rather may pose an indication for urgent transplantation.
Herrmann
M
M
Institute of Medical Microbiology, University of Muenster Hospital, Germany. herrmam@uni-muenster.de
Weyand
M
M
Greshake
B
B
von Eiff
C
C
Proctor
R A
RA
Scheld
H H
HH
Peters
G
G
D000328:Adult; D000367:Age Factors; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology*; D000075202:Contraindications; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation / Q000401:mortality*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D015996:Survival Rate; D013997:Time Factors; D016277:Ventricular Function, Left