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Non-Patient Factors Associated With Infections in LVAD Recipients: A Scoping Review
The Journal of Heart and Lung Transplantation  (IF10.247),  Pub Date : 2021-10-22, DOI: 10.1016/j.healun.2021.10.006
Supriya Shore, Michael J. Pienta, Tessa M.F. Watt, Gardner Yost, Whitney A. Townsend, Lourdes Cabrera, Michael D. Fetters, Carol Chenoweth, Keith D. Aaronson, Francis D. Pagani, Donald S. Likosky

Background

Infections are the most common complication in recipients of durable left ventricular assist devices (LVAD) and are associated with increased morbidity, mortality, and expenditures. The existing literature examining factors associated with infection in LVAD recipients is limited and principally comprises single-center studies. This scoping review synthesizes all available evidence related to identifying modifiable, non-patient factors associated with infections among LVAD recipients.

Methods

Published studies were identified through searching five bibliographic databases: PubMed, Scopus, EMBASE, CINAHL, and Web of Science Core Collection. Inclusion criteria required examination of factors associated with infections among recipients of contemporary implantable, continuous flow LVADs. Key study characteristics were extracted by four independent reviewers and current literature described narratively. The Systems Engineering Initiative for Patient Safety (SEIPS) model was used to develop a taxonomy for non-patient related factors (e.g., tasks, tools, technologies, organization, and environment) associated with infections following LVAD implantation. All analyses took place between February 2019 and May 2021.

Findings

A total of 43 studies met inclusion criteria. The majority of included studies were observational (n=37), single-center (n=29), from the U.S. (n=38), and focused on driveline infections (n=40). Among the 22 evaluated sub-domains of non-patient related factors, only two: increasing center experience and establishing a silicone-skin interface at the driveline exit site, were identified as consistently being associated with a lower risk of infection.

Conclusion

This review identified 43 studies that described non-patient related factors associated with infection in LVAD recipients. Only two factors were consistently associated with lower infection risk in LVAD recipients: increasing experience and establishing a silicone-skin interface at driveline exit site. The large variability in reporting across multiple studied interventions limited the ability to discern their effectiveness.