A Critical Challenge in the Heart Transplant Process: Left Ventricular Assist Device Infections

Abstract

Objective: This study aimed to investigate infections, microbiological agents, and factors affecting mortality in patients with end-stage heart failure who underwent left ventricular assist device (LVAD) surgery at our hospital since 2012, providing insights into patient follow-up and treatment strategies. Methods: This cross-sectional and retrospective study included 88 patients who underwent LVAD surgery at our hospital between 2012 and 2023 and subsequently developed infections. LVAD-specific and non-specific infections were classified according to the 2024 criteria of the International Society for Heart and Lung Transplantation (ISHLT). Results: A total of 88 patients who underwent LVAD implantation were included in the study. The mean age at implantation was 49.51 +/- 14.07 years, and the mean time to infection development was 17.90 +/- 13.55 months. Infections were observed in 94.3% of patients, while 45.4% developed sepsis and 53.4% had systemic inflammatory response syndrome (SIRS). The rate of intensive care unit admissions was 75.0%. Among the patients, 12.5% underwent debridement, 10.2% required complete device removal, and 6.8% underwent device exchange. The number of patients who underwent heart transplantation was 11, while 65 patients died. A total of 252 infection episodes were identified in 83 patients. The most common LVAD-specific infection was percutaneous driveline infection (40.8%). The most frequently observed clinical findings were discharge and fever, while Staphylococcus aureus and coagulase-negative staphylococci were the most commonly isolated pathogens. Nasal S. aureus carriage was detected in 27 (10.7%) patients, and among these, 16 (59.3%) patients developed S. aureus infections, which was statistically significant (p=0.001). Among Gram-negative bacteria, Pseudomonas aeruginosa and Escherichia coli were the most commonly isolated pathogens. Multidrug resistance (MDR) was observed in 35.4% of cases, while extended-spectrum beta-lactamase (ESBL) production was detected in 19.4%. Elevated creatinine levels, hypoalbuminemia, SIRS, and sepsis were found to be significantly associated with mortality (p<0.05). Additionally, age, Pitt bacteremia score, and Charlson comorbidity index were significantly higher in deceased patients, while INTERMACS scores were significantly lower (p<0.05). Conclusion: This study, conducted in patients with LVADs who have highly complex clinical conditions, provides significant insights into infection rates and factors influencing mortality. Our findings will contribute to future patient follow-up strategies and advanced-level research in this field.