Work

P48. Escalating Surgical Treatment for Left Ventricular Assist Device Infections is associated with Decreased Expected Mortality: A Clinical Risk Prediction Score

Year: 2024

Type: article

Abstract: PURPOSE: Left ventricular assist devices (LVAD) greatly improve survival for patients with end-stage cardiac failure, but LVAD infections remain a significant challenge with predictive risk factors poorly understood. Furthermore, the indications and utility of escalating treatment from medical management to surgical debridement and flap reconstruction are not well-characterized. METHODS: A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed. Primary outcomes were 90-day and overall mortality after LVAD infections. Cox proportional hazards regression was used to generate a risk-prediction score for mortality. RESULTS: Of the 760 patients undergoing primary LVAD implantation, 255 (34%) developed an LVAD infection of whom 91 (36%) were managed medically, 134 (52%) surgical debridement, and 30 (12%) with surgical debridement and flap reconstruction. One-year survival after infection was 85% with median survival of 2.40 years. Factors independently associating with mortality were diabetes (hazard ratio (HR) 1.44, p=0.04), MRSA infection (HR 1.64, p=0.03), deep space involvement (pump pocket/outflow cannula) (HR 2.26, p<0.001), ECMO after LVAD (HR 2.52, p<0.01), and MSSA infection (HR 0.63, p=0.03). A clinical risk-prediction score stratifying patients by mortality using these factors observed significant differences in median survival of 5.67 years for low-risk patients (score 0-1), 3.62 years for intermediate-risk (score 2), and 1.48 years for high-risk (score ≥3) (p<0.001). CONCLUSION: A clinical risk tool for identifying patients at high-risk of developing LVAD infection is presented, and differential management strategies are characterized. Surgeons may consider earlier surgical debridement and potential flap reconstruction to alter patient risk trajectory.

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0001018460.82750.6f