A race against time: The impact of timing of first post-implantation LVAD infection and patient outcomes

Department

Internal Medicine

Additional Department

Cardiology

Document Type

Article

Publication Title

Current Problems in Cardiology

Abstract

BACKGROUND: Left ventricular assist devices (LVADs) serve as lifesaving support for patients with advanced heart failure but are prone to infectious complications. The timing of these infections may play a crucial role in determining clinical outcomes. This study examines the differences between early (≤ 18 months) and late (> 18 months) LVAD infections.

METHODS: In this retrospective cohort study, 105 LVAD patient charts were reviewed, and 50 patients identified to have LVAD-related infections. These patients were categorized based on the timing of infection: early (≤ 18 months post-implantation) and late (> 18 months). Variables analyzed included patient demographics, infection type, microbial etiology, post-implantation complications, treatment course, relapse rates, and survival outcomes.

RESULTS: Early infections were associated with more severe LVAD infections, including higher rates of bacteremia and candidemia. It was also linked to infection with more aggressive pathogens, higher prevalence of Staphylococcus aureus in early infections (45 % vs. 26 %), a higher relapse rate (80 % vs. 63 %) (p = 0.029), and a shorter time to relapse. Among those with relapses, bacteremia was predominantly associated with the recurrence. Furthermore, early infections resulted in higher mortality (25.8 % vs. 15.7 %) and a shorter mean survival time (2.3 vs. 4 years).

CONCLUSIONS: Early LVAD infections are associated with higher relapse rates and worse clinical outcomes compared to late infections. These findings suggest that closer monitoring, more aggressive early interventions, and tailored antimicrobial strategies may improve patient outcomes in the early post-implantation period. Prospective studies are needed to validate these observations and guide infection prevention strategies in LVAD patients.

First Page

103188

DOI

10.1016/j.cpcardiol.2025.103188

Volume

50

Issue

12

Publication Date

12-1-2025

Publisher

Mosby-Year Book

Medical Subject Headings

Humans; Heart-Assist Devices; Retrospective Studies; Female; Male; Prosthesis-Related Infections; Middle Aged; Heart Failure; Time Factors; Survival Rate; Recurrence; Risk Factors; Adult; Aged

PubMed ID

41077104

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