Incidence of Driveline Infections and Sepsis in a Contemporary HVAD Population

PURPOSE: We assessed the incidence of driveline infections (DLI) and sepsis in the HVAD population using pooled data from the ENDURANCE, ENDURANCE Supplemental, and Lateral trials. METHODS: All HVAD patients enrolled in the Endurance (N=296), Endurance Supplemental (N=308), and Lateral (N=144) were assessed for DLI and sepsis events and separated into two groups: (1) driveline infection and (2) sepsis. Patients with both types were counted in both groups. Baseline characteristics and 24-month survival were compared intragroup to (1) patients with and without DLI and (2) patients with and without sepsis. RESULTS: Among the 748 patients implanted with an HVAD, 188 (25.1%) experienced 296 DLI and 137 (18.3%) experienced sepsis. Of the patients with DLI, 29 (15.4%) had subsequent sepsis. DLI occurred a mean of 538.5 days after implant (range 10-1729). Sepsis occurred a mean of 442 days post-implant (range 2-1792). Patients with DLI had larger BMI (28.4 ± 6 vs. 27.3 ± 5.6 kg/m2, p=0.02) at baseline. Patients with sepsis were older (65.7 ± 10.2 vs 61 ± 12.3 years, p<0.0001), had more ischemic HF (62.8% vs 49.6%, p=0.005), were more likely diabetic (51.1% vs 36.3%, p=0.001) (Table 1). Patients with DLI had better 2-year survival than those without DLI (88.1% vs 63.5%, p<0.0001). However, patients with sepsis had worse 2-year survival than those without sepsis (55.5% vs 73.9%, p<0.0001) (Figure 1). CONCLUSION: The incidence of DLI and sepsis remains stable in the LVAD population. Risk factors for sepsis include diabetes and ischemic etiology. While sepsis is a risk factor for mortality, the occurrence of DLI does not have an adverse effect on survival.