Abstract 4369911: Prevalence and Risk Factors for Ventricular Assist Device-Associated Infection in Children: An Analysis of the ACTION Registry

Abstract

Background: Ventricular assist devices (VAD) are increasingly used to bridge children to heart transplant. Infection associated with extracorporeal VAD components remains a common source of morbidity. The aim of this study was to determine contemporary prevalence and risk factors for VAD-associated infection in children. Methods: A retrospective analysis of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry evaluated patients implanted with left or single VAD from 01/04/18−04/30/25. Patients were classified based intracorporeal (IC) vs paracorporeal (PC) VAD, with further subdivision of the PC group by temporary vs durable (Berlin EXCOR®) cannulas at time of infection. Patients with and without VAD-associated infection (major infection – percutaneous site and/or pocket, internal pump component, inflow or outflow tract) were compared overall and by VAD type. Risk factors for VAD-associated infection were evaluated with multivariate analysis. One-year survival after infection was assessed using Kaplan Meier survival curve. Results: Of the 1527 patients included, 442 (28.9%) had IC VAD and 1085 (71.1%) PC VAD (964 durable, 121 temporary cannulas). There were 152 (10%) patients who developed VAD-associated infection, with no difference in one-year survival (Figure 1). While infection was more common for patients on PC VAD overall (PC n=94 vs IC n=58), patients on IC VAD had proportionately higher rate of infection (13.1% vs PC durable 9.3% vs PC temporary 3.3%) (p<0.05). Median time to infection was significantly later for IC vs PC VAD (143 vs 52.5 days, p<0.0001). Age, gender, diagnosis, INTERMACS profile, renal or liver dysfunction, past cardiac surgery and pre-VAD ECMO or ventilator use were not significantly different between patients with or without infection. While greater weight, device strategy and cannula cohort were significant in the univariate risk model, only cannula cohort approached significance in the multivariate model, with PC temporary protective (OR 0.38, 95%CI 0.13-1.05, p=0.061) and IC increasing risk (OR 1.43, 95%CI 0.98-2.10, p=0.066) when compared to PC durable VAD. Conclusion: Nearly 1 in 10 children developed a VAD-associated infection. Fortunately, one-year survival was not worse for those with infection. Infection was proportionately higher for IC vs PC VAD, likely largely driven by longer time on device. Further studies on driveline management for IC VAD may help reduce morbidity for those on chronic VAD support.