Heterogeneity in HeartMate 3 implanting center infection management reveals opportunities for quality improvement and best practice initiatives during left ventricular assist device support

Jennifer A. Cowger, Henry Ford Hospital Health, Department of Cardiovascular Medicine, Detroit, MI, Associate Professor Michigan State University, Lansing, MI. Electronic address: jennifercowger@gmail.com.
Sarah Schettle, Mayo Clinic, Department of Cardiovascular Surgery, Rochester, MN.
Francis D. Pagani, University of Michigan, Michigan Medicine, Department of Cardiac Surgery, Ann Arbor, MI.
Farooq H. Sheikh, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC.
Jennifer M. Hajj, Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC.
Kulpreet Barn, Robert Wood Johnson Barnabas Health System, New Jersey.
James K. Kirklin, Kirklin Solutions, Inc.
Brandon Singletary, Kirklin Solutions, Inc.
Ezequiel J. Molina, Piedmont Heart Institute, Department of Cardiac Surgery, Atlanta, GA.
Edward Soltesz, Cleveland Clinic, Heart, Vascular, and Thoracic Institute, Cleveland, OH.
Mirnela Byku, University of North Carolina Medical Center, Chapel Hill, NC.
Mani Daneshmand, Emory University Hospital, Department of Surgery, Atlanta, GA.
Nir Uriel, Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY.
Laura Coyle, Advocate Health - MidwestFollow
Katherine L. Wood, Newark Beth Israel Medical Center, RWJBH Northern Department of Cardiothoracic Surgery, Newark, NJ.
Kelly O'Connell, Abbott Inc, Abbott Parkway, IL.
Robert Kormos, Professor Emeritus of Cardiothoracic Surgery and Bioengineering, University of Pittsburgh, PA.
Manreet K. Kanwar, Division of Cardiology, Department of Medicine, University of Chicago, Chicago, IL.

Affiliations

Advocate Christ Medical Center

Abstract

Background: There is marked variability in device-related (DR) infection frequencies across HeartMate 3 (HM3) centers.

Objectives: The goal is to correlate center driveline (DL) management and infection mitigation practices with DR-infection development, laying foundation for development of best practice recommendations for one facet of HM3 patient care.

Methods: Coordinators at 30 HM3 centers were surveyed about center practices for infection prophylaxis, intraoperative DL placement and postoperative care, and infection mitigation. Early (≤90 days) and late (>90 day) center DR-infection frequencies were calculated from Society of Thoracic Surgeons Intermacs data linkage. Correlations between center practice patterns and incident DR-infection were examined with multivariable Cox modelling (clustering adjusted hazard ratio (aHR)).

Results: Within Intermacs (3725 patients), 1-year freedom from DR-infection was 87% (80.6-87.3%). Initially, DL dressing changes were performed daily, weekly, and variably at 48%, 21% and 31% of centers. After 4 weeks, 57% deescalated dressing changes to weekly. Chlorhexidine cleanser with a silver-impregnated dressing (Chl-Sil) was standard at 52.7% of programs; 47.3% used chlorhexidine alone or other supplies. Use of Chl-Sil was associated with reduced early (aHR 0.48, p=0.004) and late (aHR 0.64, p=0.02) DR-infection while frequent dressing changes conferred higher late DR-infection (aHR 1.4 p=0.05). Antibiotic prophylaxis, DL tunneling, and diabetes practices did not correlate with DR-infection.

Conclusions: Given the burden of DR-infections, best practice recommendations are needed to standardize care. Application of Chl-Sil DL dressings could be a first step in achieving care standardization, while frequent dressing changes following DL incorporation should be avoided.

Document Type

Article

PubMed ID

40738195

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