Does infection predispose to thrombosis during long‐term ventricular assist device support?. Issue 7 (27th February 2022)

• Record Type: Journal Article
• Authors: Bouzas‐Cruz, Noelia; Castrodeza, Javier; Gonzalez‐Fernandez, Oscar; Ferrera, Carlos; Woods, Andrew; Tovey, Sian; Robinson‐Smith, Nicola; McDiarmid, Adam K.; Parry, Gareth; Samuel, Julie; Schueler, Stephan; MacGowan, Guy A.
• Is Part Of: Artificial organs. Volume 46:Issue 7(2022)
• Page Start: 1399
• Page End: 1408
• Publication Date: 2022-02-27
• Subjects: combined thrombotic event -- HeartWare left ventricular assist device -- infection -- ischaemic stroke -- pump thrombosis -- transient ischaemic attack -- ventricular assist device; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.14209
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: Background: Infections and thrombotic events remain life‐threatening complications in patients with ventricular assist devices (VAD). Methods: We describe the relationship between both events in our cohort of patients ( n = 220) supported with the HeartWare VAD (HVAD). This is a retrospective analysis of patients undergoing HVAD implantation between July 2009 and March 2019 at the Freeman Hospital, Newcastle upon Tyne, United Kingdom. Results: Infection was the most common adverse event in HVAD patients, with 125 patients (56.8%) experiencing ≥ one infection ( n = 168, 0.33 event per person year (EPPY)), followed by pump thrombosis (PT) in 61 patients (27.7%, 0.16 EPPY). VAD‐specific infections were the largest group of infections. Of the 125 patients who had an infection, 66 (53%) had a thrombotic event. Both thrombotic events and infections were related to the duration of support, though there was only limited evidence that infections predispose to thrombosis. Those with higher than median levels of C‐reactive protein during the infection were more likely to have an ischaemic stroke (IS) (34.5% vs 16.7%, p = .03), though not PT or a combined thrombotic event (CTE: first PT or IS). However, in multivariate analysis, there was no significant effect of infection predisposing to CTE. Conclusions: Infection and thrombotic events are significant adverse events related to the duration of support in patients receiving HVADs. Infections do not clearly predispose to thrombotic events. Abstract : We retrospectively investigated 220 patients undergoing HVAD‐implantation between July´2009 and March´2019 atour institution. Infections and thrombotic eventswere more common on long‐term supported patients. Those with higher CRP levels during the infection were more likely to have ischaemic stroke(IS), though not PT. In multivariate analysis there was no significant effect of infection determining thrombotic events. In summary, both thrombotic events and infections were related to the duration of support. However, Infections do not clearly predispose to thrombosis events.