OBJECTIVES: In patients supported by a durable left ventricular assist device (LVAD), infections are a frequently reported adverse event with increased morbidity and mortality. The purpose of this study was to investigate the possible association between infections and thromboembolic events, most notable cerebrovascular accidents (CVAs), in LVAD patients. METHODS: An analysis of the multicentre European Registry for Patients Assisted with Mechanical Circulatory Support was performed. Infections were categorized as VAD-specific infections, VAD-related infections and non-VAD-related infections. An extended Kaplan-Meier analysis for the risk of CVA with infection as a time-dependent covariate and a multivariable Cox proportional hazard model were performed. RESULTS: For this analysis, 3282 patients with an LVAD were included with the majority of patients being male (83.1%). During follow-up, 1262 patients suffered from infection, and 457 patients had a CVA. Cox regression analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for CVA of 1.90 [95% confidence interval (CI): 1.55-2.33; P < 0.001]. Multivariable analysis confirmed the association for infection and CVAs with an HR of 1.99 (95% CI: 1.62-2.45; P < 0.001). With infections subcategorized, VAD-specific HR was 1.56 (95% CI: 1.18-2.08; P 0.002) and VAD-related infections [HR: 1.99 (95% CI: 1.41-2.82; P < 0.001)] remained associated with CVAs, while non-VAD-related infections (P = 0.102) were not. CONCLUSIONS: Infection during LVAD support is associated with an increased risk of developing an ischaemic or haemorrhagic CVA, particularly in the setting of VAD-related or VAD-specific infections. This suggests the need of a stringent anticoagulation management and adequate antibiotic treatment during an infection in LVAD-supported patients.

Clinic for Thoracic and Cardiovascular Surgery Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Germany

Department of Cardiac Surgery University Hospitals Leuven Leuven Belgium

Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany

Department of Heart and Vessels Cardiac Surgery Unit and Heart Transplantation Center S Camillo Forlanini Hospital Roma Italy

Department of Internal Cardiology Medicine Marasyk University Brno Czech Republic

Department of Medical Microbiology and Infectious Diseases Erasmus MC University Medical Center Rotterdam Rotterdam Netherlands

DZHK Partner Site Berlin Berlin Germany

EUROMACS European Association for Cardio Thoracic Surgery Windsor UK

Heart and Vascular Center Semmelweis University Budapest Hungary

Thoraxcenter Department of Cardiology Erasmus MC University Medical Center Rotterdam Rotterdam Netherlands

Thoraxcenter Department of Cardiothoracic Surgery Erasmus MC University Medical Center Rotterdam Rotterdam Netherlands

Eur J Cardiothorac Surg. 2022 Oct 4;62(5):ezac471. doi: 10.1093/ejcts/ezac471. PubMed

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The fourth report of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardiothoracic Surgery: focus on standardized outcome ratios