title: Continuous-flow devices and percutaneous site infections: clinical outcomes.
abstract: BACKGROUND
  Although continuous-flow left ventricular assist device (LVAD) support has become standard therapy, the complexities of device and patient management remain a challenge. In particular, percutaneous site infections (PSI) are a serious complication during the post-implant course. We sought to study the incidence, risk factors, and clinical effect of PSI.
  
  
  METHODS
  Data were obtained from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Registry. All adult patients who received a primary intracorporeal continuous flow LVAD between June 2006 and September 2010 were included. Descriptive statistics, Kaplan-Meier depictions, and multivariable analysis in the parametric hazard domain were used for statistical analysis.
  
  
  RESULTS
  A total of 239 PSIs were documented in 197 of 2,006 recipients (9.8%) of a continuous-flow LVAD. Mean follow-up was 8.1 months. Mean time to development of a PSI was 6.6 months. At 1 year after implant, nearly 19% of continuous-flow LVAD recipients developed a PSI. Multivariate analysis showed younger age (hazard ratio, 1.20; p < 0.0001) was the only factor predicting a PSI. Continuous-flow LVAD recipients who did not develop a PSI had improved survival (p = 0.004). Twenty-three patients died after development of a PSI. Sepsis was the most common cause of death (26.1%).
  
  
  CONCLUSIONS
  PSIs occur in approximately 19% of continuous-flow LVAD recipients by 12 months after implant. Young age is the only predictor of PSI. Importantly, development of a PSI adversely affects survival. Efforts to enhance driveline integration and to develop future totally implantable systems are warranted.
authors: Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY, USA. dgoldste@montefiore.org
authors: Daniel J
authors: DJ
authors: Goldstein
authors: David
authors: D
authors: Naftel
authors: William
authors: W
authors: Holman
authors: Lavanya
authors: L
authors: Bellumkonda
authors: Salpy V
authors: SV
authors: Pamboukian
authors: Francis D
authors: FD
authors: Pagani
authors: James
authors: J
authors: Kirklin
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*