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Left Ventricular Assist Device Infections: A Systematic Review

O’Horo, John, C.*,†; Abu Saleh, Omar, M.*; Stulak, John, M.; Wilhelm, Mark, P.*; Baddour, Larry, M.*,§; Rizwan Sohail, M.*,§

doi: 10.1097/MAT.0000000000000684
Review Article

Left ventricular assist devices (LVADs) are becoming a more frequent life-support intervention. Gaining an understanding of risk factors for infection and management strategies is important for treating these patients. We conducted a systematic review and meta-analysis of studies describing infections in continuous-flow LVADs. We evaluated incidence, risk factors, associated microorganisms, and outcomes by type of device and patient characteristics. Our search identified 90 distinct studies that reported LVAD infections and outcomes. Younger age and higher body mass index were associated with higher rates of LVAD infections. Driveline infections were the most common infection reported and the easiest to treat with fewest long-term consequences. Bloodstream infections were not reported as often, but they were associated with stroke and mortality. Treatment strategies varied and did not show a consistent best approach. LVAD infections are a significant cause of morbidity and mortality in LVAD patients. Most research comes from secondary analyses of other LVAD studies. The lack of infection-oriented research leaves several areas understudied. In particular, bloodstream infections in this population merit further research. Providers need more research studies to make evidence-based decisions about the prevention and treatment of LVAD infections.

From the *Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota

Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

§Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Submitted for consideration March 2017; accepted for publication in revised form July 2017.

Disclosures: Dr. Sohail reports receiving funds from TYRX, Inc, and Medtronic for prior research unrelated to this study and honoraria/consulting fees from Medtronic, Spectranetics, and Boston Scientific. Dr Baddour receives financial support unrelated to this research from UpToDate royalties and the Massachusetts Medical Society for his duties as Editor-in-Chief of NEJM Journal Watch Infectious Diseases.

This project was supported in part by grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). This publication was also made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: John C. O’Horo, Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email: ohoro.john@mayo.edu.

Copyright © 2018 by the American Society for Artificial Internal Organs