Continuous-flow devices and percutaneous site infections: Clinical outcomes

Daniel J. Goldstein, David Naftel, William Holman, Lavanya Bellumkonda, Salpy V. Pamboukian, Francis D. Pagani, James Kirklin

Research output: Contribution to journalArticle

118 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1151-1157
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume31
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Heart-Assist Devices
Equipment and Supplies
Infection
Registries
Survival
Cause of Death
Sepsis
Cohort Studies
Multivariate Analysis

Keywords

  • continuous flow
  • driveline infection
  • left ventricular assist device
  • long term complication
  • percutaneous site infections

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Goldstein, D. J., Naftel, D., Holman, W., Bellumkonda, L., Pamboukian, S. V., Pagani, F. D., & Kirklin, J. (2012). Continuous-flow devices and percutaneous site infections: Clinical outcomes. Journal of Heart and Lung Transplantation, 31(11), 1151-1157. https://doi.org/10.1016/j.healun.2012.05.004

Continuous-flow devices and percutaneous site infections : Clinical outcomes. / Goldstein, Daniel J.; Naftel, David; Holman, William; Bellumkonda, Lavanya; Pamboukian, Salpy V.; Pagani, Francis D.; Kirklin, James.

In: Journal of Heart and Lung Transplantation, Vol. 31, No. 11, 11.2012, p. 1151-1157.

Research output: Contribution to journalArticle

Goldstein, DJ, Naftel, D, Holman, W, Bellumkonda, L, Pamboukian, SV, Pagani, FD & Kirklin, J 2012, 'Continuous-flow devices and percutaneous site infections: Clinical outcomes', Journal of Heart and Lung Transplantation, vol. 31, no. 11, pp. 1151-1157. https://doi.org/10.1016/j.healun.2012.05.004
Goldstein, Daniel J. ; Naftel, David ; Holman, William ; Bellumkonda, Lavanya ; Pamboukian, Salpy V. ; Pagani, Francis D. ; Kirklin, James. / Continuous-flow devices and percutaneous site infections : Clinical outcomes. In: Journal of Heart and Lung Transplantation. 2012 ; Vol. 31, No. 11. pp. 1151-1157.
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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.",
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AU - Pamboukian, Salpy V.

AU - Pagani, Francis D.

AU - Kirklin, James

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N2 - 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.

AB - 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.

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