Background
Ventricular assist device (VAD) implantation has become an effective option for patients
with severe heart failure. However, device-related infections remain a significant
problem. The aim of this study was to describe the incidence and microbiological aetiology
of bacteraemia in patients with VADs, and to assess the impact of bacteraemia on clinical
outcomes.
Methods
A retrospective study was conducted of patients having VAD implantation at the Alfred
Hospital (Melbourne, Australia) from October 1990 to July 2009. Medical records and
microbiology databases were reviewed. Patients who were supported with a VAD for 72 h or more were evaluated for demographic data, VAD type, the occurrence of bacteraemia
and clinical outcomes.
Results
During the 19-year period, 135 VAD patients (89 Thoratec PVAD, 10 Novacor, and 36
Ventrassist) supported for a total duration of 17,304 (median 74) support days were
included. Sixty-one patients (45%) developed VAD-associated bacteraemia, an incidence
of 5.6 episodes per 1000 support days. The incidence of bacteraemia per 1000 days
of support was similar for the three devices used: Thoratec PVAD, Novacor and Ventrassist
VADs (7.8 ± 0.8, 5.2 ± 1.5 and 3.4 ± 0.5, respectively, p = 0.74). Staphylococcus aureus was the most common pathogen (25%). The rates of death on device, survival to transplant,
recovery with explant and outcomes after transplantation, including 30-day mortality,
median survival time and incidence of cerebrovascular accidents were not significantly
impacted upon by bacteraemia.
Conclusions
Bacteraemia is common in VAD patients. However, the incidence of VAD-associated bacteraemia
is independent of device type and with aggressive antimicrobial therapy; clinical
outcomes need not be affected by the bacteraemia.
Keywords
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Article info
Publication history
Published online: November 25, 2013
Accepted:
September 16,
2013
Received in revised form:
September 13,
2013
Received:
January 29,
2013
Identification
Copyright
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
