Infectious complications of ventricular assist device use in children in the United States: Data from the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

Scott R. Auerbach, Marc E. Richmond, Kurt R. Schumacher, Dalia Lopez-Colon, Max B. Mitchell, Mark Turrentine, Ryan S. Cantor, Robert A. Niebler, Pirooz Eghtesady

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Infections are frequent in pediatric ventricular assist device (VAD) patients. In this study we aimed to describe infections in durable VAD patients reported to Pedimacs. Methods: Durable VAD data from the Pedimacs registry (September 19, 2012 to December 31, 2015) were analyzed. Infections were described with standard descriptive statistics, Kaplan-Meier analysis and competing outcomes analysis. Results: There were 248 implants in 222 patients, with a mean age and a median follow-up of 11 ± 6.4 years and 2.4 patient-months (<1 day to 2.6 years), respectively. Device types were pulsatile flow (PF) in 91 (41%) patients and continuous flow (CF) in 131 (59%) patients. PF patients were younger (4 ± 4 vs 14 ± 4 years; p < 0.0001) and were more likely to have congenital heart disease (25% vs 12%; p = 0.03), prior surgery (53% vs 26%; p < 0.0001) and prior extracorporeal membrane oxygenation (24% vs 7%; p = 0.0003). Infection accounted for 17% (96 of 564) of the reported adverse events (AEs). A non-device infection was most common (51%), followed by sepsis (24%), external pump component infection (20%) and internal pump component infection (5%). Most infections were bacterial (73%) and required intravenous therapy only (77%). The risk of infection in the constant phase was higher in patients with a history of prior infection and in patients with a history of a non-infectious major AEs. Survival was lower after infection only in CF patients (p = 0.008). Conclusions: Infection was the most common AE after pediatric VAD implantation. Non-device infections were most common. The best predictor of a future infection was a past infection. CF patients have higher risk of death after an infection.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart-Assist Devices
Registries
Pediatrics
Infection
Pulsatile Flow
Extracorporeal Membrane Oxygenation
Kaplan-Meier Estimate
Bacterial Infections

Keywords

  • Adverse events
  • Continuous-flow device
  • Infection
  • Pulsatile-flow device
  • Ventricular assist device

ASJC Scopus subject areas

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

Cite this

Infectious complications of ventricular assist device use in children in the United States : Data from the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). / Auerbach, Scott R.; Richmond, Marc E.; Schumacher, Kurt R.; Lopez-Colon, Dalia; Mitchell, Max B.; Turrentine, Mark; Cantor, Ryan S.; Niebler, Robert A.; Eghtesady, Pirooz.

In: Journal of Heart and Lung Transplantation, 2017.

Research output: Contribution to journalArticle

Auerbach, Scott R. ; Richmond, Marc E. ; Schumacher, Kurt R. ; Lopez-Colon, Dalia ; Mitchell, Max B. ; Turrentine, Mark ; Cantor, Ryan S. ; Niebler, Robert A. ; Eghtesady, Pirooz. / Infectious complications of ventricular assist device use in children in the United States : Data from the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). In: Journal of Heart and Lung Transplantation. 2017.
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abstract = "Background: Infections are frequent in pediatric ventricular assist device (VAD) patients. In this study we aimed to describe infections in durable VAD patients reported to Pedimacs. Methods: Durable VAD data from the Pedimacs registry (September 19, 2012 to December 31, 2015) were analyzed. Infections were described with standard descriptive statistics, Kaplan-Meier analysis and competing outcomes analysis. Results: There were 248 implants in 222 patients, with a mean age and a median follow-up of 11 ± 6.4 years and 2.4 patient-months (<1 day to 2.6 years), respectively. Device types were pulsatile flow (PF) in 91 (41{\%}) patients and continuous flow (CF) in 131 (59{\%}) patients. PF patients were younger (4 ± 4 vs 14 ± 4 years; p < 0.0001) and were more likely to have congenital heart disease (25{\%} vs 12{\%}; p = 0.03), prior surgery (53{\%} vs 26{\%}; p < 0.0001) and prior extracorporeal membrane oxygenation (24{\%} vs 7{\%}; p = 0.0003). Infection accounted for 17{\%} (96 of 564) of the reported adverse events (AEs). A non-device infection was most common (51{\%}), followed by sepsis (24{\%}), external pump component infection (20{\%}) and internal pump component infection (5{\%}). Most infections were bacterial (73{\%}) and required intravenous therapy only (77{\%}). The risk of infection in the constant phase was higher in patients with a history of prior infection and in patients with a history of a non-infectious major AEs. Survival was lower after infection only in CF patients (p = 0.008). Conclusions: Infection was the most common AE after pediatric VAD implantation. Non-device infections were most common. The best predictor of a future infection was a past infection. CF patients have higher risk of death after an infection.",
keywords = "Adverse events, Continuous-flow device, Infection, Pulsatile-flow device, Ventricular assist device",
author = "Auerbach, {Scott R.} and Richmond, {Marc E.} and Schumacher, {Kurt R.} and Dalia Lopez-Colon and Mitchell, {Max B.} and Mark Turrentine and Cantor, {Ryan S.} and Niebler, {Robert A.} and Pirooz Eghtesady",
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T1 - Infectious complications of ventricular assist device use in children in the United States

T2 - Data from the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)

AU - Auerbach, Scott R.

AU - Richmond, Marc E.

AU - Schumacher, Kurt R.

AU - Lopez-Colon, Dalia

AU - Mitchell, Max B.

AU - Turrentine, Mark

AU - Cantor, Ryan S.

AU - Niebler, Robert A.

AU - Eghtesady, Pirooz

PY - 2017

Y1 - 2017

N2 - Background: Infections are frequent in pediatric ventricular assist device (VAD) patients. In this study we aimed to describe infections in durable VAD patients reported to Pedimacs. Methods: Durable VAD data from the Pedimacs registry (September 19, 2012 to December 31, 2015) were analyzed. Infections were described with standard descriptive statistics, Kaplan-Meier analysis and competing outcomes analysis. Results: There were 248 implants in 222 patients, with a mean age and a median follow-up of 11 ± 6.4 years and 2.4 patient-months (<1 day to 2.6 years), respectively. Device types were pulsatile flow (PF) in 91 (41%) patients and continuous flow (CF) in 131 (59%) patients. PF patients were younger (4 ± 4 vs 14 ± 4 years; p < 0.0001) and were more likely to have congenital heart disease (25% vs 12%; p = 0.03), prior surgery (53% vs 26%; p < 0.0001) and prior extracorporeal membrane oxygenation (24% vs 7%; p = 0.0003). Infection accounted for 17% (96 of 564) of the reported adverse events (AEs). A non-device infection was most common (51%), followed by sepsis (24%), external pump component infection (20%) and internal pump component infection (5%). Most infections were bacterial (73%) and required intravenous therapy only (77%). The risk of infection in the constant phase was higher in patients with a history of prior infection and in patients with a history of a non-infectious major AEs. Survival was lower after infection only in CF patients (p = 0.008). Conclusions: Infection was the most common AE after pediatric VAD implantation. Non-device infections were most common. The best predictor of a future infection was a past infection. CF patients have higher risk of death after an infection.

AB - Background: Infections are frequent in pediatric ventricular assist device (VAD) patients. In this study we aimed to describe infections in durable VAD patients reported to Pedimacs. Methods: Durable VAD data from the Pedimacs registry (September 19, 2012 to December 31, 2015) were analyzed. Infections were described with standard descriptive statistics, Kaplan-Meier analysis and competing outcomes analysis. Results: There were 248 implants in 222 patients, with a mean age and a median follow-up of 11 ± 6.4 years and 2.4 patient-months (<1 day to 2.6 years), respectively. Device types were pulsatile flow (PF) in 91 (41%) patients and continuous flow (CF) in 131 (59%) patients. PF patients were younger (4 ± 4 vs 14 ± 4 years; p < 0.0001) and were more likely to have congenital heart disease (25% vs 12%; p = 0.03), prior surgery (53% vs 26%; p < 0.0001) and prior extracorporeal membrane oxygenation (24% vs 7%; p = 0.0003). Infection accounted for 17% (96 of 564) of the reported adverse events (AEs). A non-device infection was most common (51%), followed by sepsis (24%), external pump component infection (20%) and internal pump component infection (5%). Most infections were bacterial (73%) and required intravenous therapy only (77%). The risk of infection in the constant phase was higher in patients with a history of prior infection and in patients with a history of a non-infectious major AEs. Survival was lower after infection only in CF patients (p = 0.008). Conclusions: Infection was the most common AE after pediatric VAD implantation. Non-device infections were most common. The best predictor of a future infection was a past infection. CF patients have higher risk of death after an infection.

KW - Adverse events

KW - Continuous-flow device

KW - Infection

KW - Pulsatile-flow device

KW - Ventricular assist device

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