Management and outcomes of left ventricular assist device-associated endocarditis: A systematic review

Sinal Patel, Syed Saif Abbas Rizvi, Jae Hwan Choi, Dylan P. Horan, Matthew P. Weber, Elizabeth J. Maynes, Jessica G.Y. Luc, Nana Aburjania, John W. Entwistle, Rohinton J. Morris, Howard T. Massey, Vakhtang Tchantchaleishvili*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Background: Left ventricular assist device (LVAD)-associated endocarditis remains poorly studied, especially in newer continuous-flow LVADs (CF-LVADs). The aim of this review was to assess outcomes of patients with LVAD-associated endocarditis, as stratified by CF-LVAD and pulsatile LVAD (P-LVAD) use as well as by different interventions and pathogen types. Methods: An electronic search was performed to identify studies in the English literature on LVAD-associated endocarditis. Results: Overall, 16 articles with 26 patients were included; seven had CF-LVADs and 19 had P-LVADs; time to development of endocarditis was 91 days (152 vs. 65 days, respectively, P=0.05). Eleven of 25 patients were treated with antibiotics only. Remaining 14 patients received antibiotics, however, they also underwent additional surgical intervention. One patient was treated with embolization alone for mycotic aneurysm and was therefore excluded. At a median follow-up time of 344 days post implant, there was no difference in overall mortality between CF-LVAD and P-LVAD-associated endocarditis patients (57.9% vs. 42.9%, P=0.81). Patients who underwent additional surgical intervention had higher overall survival compared to those treated with antibiotics alone (71.4% vs. 27.3%, P=0.07); with no difference in outcomes amongst those who underwent surgical device exchange as compared to heart transplantation (80.0% vs. 66.7%; P=0.23) Conclusions: Compared to patients with P-LVADs, CF-LVAD patients appeared to be resistant to early development of LVAD-associated endocarditis. There was a trend towards high survival observed amongst patients who underwent additional surgical intervention as compared to those treated with antibiotics alone, with no difference amongst surgical device exchange as compared to heart transplantation. Advantages of additional surgical intervention vs. medical therapy alone deserves further exploration to determine its applicability in CF-LVADs.

Original languageEnglish
Pages (from-to)600-609
Number of pages10
JournalAnnals of Cardiothoracic Surgery
Volume8
Issue number6
DOIs
StatePublished - 2019
Externally publishedYes

Keywords

  • Endocarditis
  • Infection
  • Left ventricular assist device (LVAD)

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