Management and Outcome of Left Ventricular Assist Device Infections in Patients Undergoing Cardiac Transplantation
Zerelda Esquer Garrigos, Natalia E. Castillo Almeida, Pooja Gurram, Prakhar Vijayvargiya, Cristina Corsini Campioli, John M. Stulak, Stacey A. Rizza, Larry M. Baddour, M. Rizwan Sohail
Abstract
BACKGROUND: Postoperative management of patients undergoing cardiac transplantation with an infected left ventricular assist device (LVAD) is unclear. METHODS: We retrospectively screened all adults with an LVAD who underwent cardiac transplantation at our institution from 2010 through 2018. We selected all cases of LVAD-specific and LVAD-related infections who were receiving antimicrobial therapy as initial treatment course or chronic suppression at the time of cardiac transplantation. Non-LVAD infections, superficial driveline-infection, or concurrent use of right ventricular assist device or extracorporeal membrane oxygenation device were excluded. RESULTS: = .005). Of the 18 cases of infection, 13 of 18 (72.2%) were classified as LVAD-specific and 5 of 18 (27.8%) were classified as LVAD-related. Nine of 13 (69.2%) cases had proven LVAD-specific infections. Antimicrobial therapy was extended posttransplant to treat preceding LVAD-specific infection in all 9 cases (9 of 13, 69.2%) with a median duration of 14 days (interquartile range, 14-28). After LVAD removal, antimicrobial treatment was not continued for preceding LVAD-related infections. CONCLUSIONS: Patients with an LVAD-specific infection were treated with 2 weeks of pathogen-directed therapy postheart transplant without any relapses. For those without LVAD-specific infection or uncomplicated LVAD-related bacteremia who had completed antimicrobial therapy pretransplant, antibiotics were discontinued after standard perioperative prophylaxis and no relapses were observed.