Device exchange versus nonexchange modalities in left ventricular assist device-specific infections: A systematic review and meta-analysis
Tyler M. Bauer
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorJae Hwan Choi
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorJessica G.Y. Luc
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorMatthew P. Weber
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorSinal Patel
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorElizabeth J. Maynes
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorAndrew J. Boyle
Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorLouis E. Samuels
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorJohn W. Entwistle
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorRohinton J. Morris
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorH. Todd Massey
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorCorresponding Author
Vakhtang Tchantchaleishvili
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Correspondence
Vakhtang Tchantchaleishvili, Division of Cardiothoracic Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107.
Email: [email protected]
Search for more papers by this authorTyler M. Bauer
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorJae Hwan Choi
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorJessica G.Y. Luc
Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorMatthew P. Weber
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorSinal Patel
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorElizabeth J. Maynes
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorAndrew J. Boyle
Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorLouis E. Samuels
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorJohn W. Entwistle
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorRohinton J. Morris
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorH. Todd Massey
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Search for more papers by this authorCorresponding Author
Vakhtang Tchantchaleishvili
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
Correspondence
Vakhtang Tchantchaleishvili, Division of Cardiothoracic Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107.
Email: [email protected]
Search for more papers by this authorFunding information
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Abstract
No standardized treatment algorithm exists for the management of continuous-flow left ventricular assist device (CF-LVAD)-specific infections. The aim of this systematic review and meta-analysis was to compare the outcomes of CF-LVAD-specific infections as managed by device exchange to other treatment modalities not involving device exchange. Electronic search was performed to identify all studies in the English literature relating to the management of CF-LVAD-specific infections. All identified articles were systematically assessed for selection criteria. Thirteen studies with 158 cases of CF-LVAD-specific infection were pooled for analysis. Overall, 18/158 (11.4%) patients underwent CF-LVAD exchange, and 140/158 (88.6%) patients were treated with non-exchange modalities. The proportion of patients with isolated driveline infections or pump or pocket infections did not differ significantly between the groups. During a mean follow-up of 290 days, there were no significant differences in the overall mortality [exchange 17.6% (4.3–50.6) vs. non-exchange 23.3% (15.8–32.9), P = 0.67] and infection recurrence rates [exchange 26.7% (8.7–58.0) vs. non-exchange 38.6% (15.4–68.5), P = 0.56]. In the setting of CF-LVAD-specific infections, device exchange does not appear to confer an advantage in the overall mortality and infection recurrence as compared to non-exchange modalities.
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