Despite Improved Survival, LVAD Patients Face High Infection Rates

Michigan Medicine 2/5/19

A team of researchers are looking at all angles to figure out how to reduce the rates of health-care-associated infections for patients who get ventricular assist devices.

Once used as a temporary helper while a person waited for a new heart, ventricular assist devices are now increasingly used as a long-term treatment.

This increase in destination therapy for advanced heart failure means another option is available to those who aren’t candidates for transplant and need more than medication.

It also means a wider population of patients receive the implant surgeries.

Although the design of available VADs continues to improve — in part leading the Food and Drug Administration last year to approve a popular device for extended use — a significant problem persists after surgery.

“About 60 percent of VAD patients develop an infection within 90 days,” says Donald Likosky, Ph.D., M.S., associate professor of cardiac surgery at the University of Michigan Frankel Cardiovascular Center. “VADs are lifesaving devices, but they come with a great deal of associated risk, including a 5.5-fold risk of one-year mortality after infection.”

That’s why Likosky is teaming up with a group of experts who bring their knowledge on infectious diseases, cardiac surgery, health services research, application of qualitative data and more to address this issue. The group plans to comb through clinical data and billing data and then conduct in-person interviews and site visits during the five-year study period.

The ultimate goal? To create a toolkit with evidence-based recommendations that all hospitals implanting ventricular assist devices will use to reduce the rates of health-care-associated infections for those patients.

U-M is the ideal center to figure out how to reduce infection in LVAD patients, Likosky says, because of the wide range of talent available for complex investigations.

“Because the goal isn’t always transplant anymore, preventing infection is even more critical,” says Preeti Malani, M.D., MSJ, another designer of this study and a professor of internal medicine at the U-M Medical School who specializes in infectious diseases and geriatrics. “We need to think about prevention in the short and the long term.”

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