• J. Cardiothorac. Vasc. Anesth. · Feb 2018

    Observational Study

    Factors Related to the Severity of Early Postoperative Infection After Heart Transplantation in Patients Surviving Prolonged Mechanical Support Periods: Experience at a Single University.

    • Ryuichiro Abe, Sho C Shibata, Shunsuke Saito, Yasumasa Tsukamoto, Koichi Toda, Akinori Uchiyama, Yasushi Sakata, Yoshiki Sawa, Kazunori Tomono, and Yuji Fujino.
    • Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
    • J. Cardiothorac. Vasc. Anesth. 2018 Feb 1; 32 (1): 53-59.

    ObjectiveThe authors examined the effect of prolonged support with continuous-flow ventricular assist devices (CF-VADs) and other related factors on the severity of infections within 30 days of heart transplantation (HTx).DesignA retrospective analysis of consecutive HTx procedures.SettingUniversity hospital, between 2010 and 2016.ParticipantsA cohort of 53 heart transplantation recipients (median age, 38.5 yr; interquartile range [IQR], 30.3-49.2 yr; women, 34%).InterventionsForty-nine patients required CF-VAD support (median duration, 946 d; IQR, 600-1,132 d).Measurements And Main ResultsSeverity of postoperative infections was categorized as follows: no infection, minor infection (resolved within 14 days), major infection (resolved after >14 days), and severe infection (septic shock). Results were expressed as number (frequency) and median with IQR. Potential risk factors for increased infection severity were expressed as odds ratio (OR) with 95% confidence interval (CI). Postoperatively, no infection, minor infection, major infection, and severe infection occurred in 32 (60.4%), 8 (15.1%), 8 (15.1%), and 5 patients (9.4%), respectively. Active ventricular assist device (VAD)-specific infections at the time of HTx occurred in 37.7% of patients. Moderate-to-severe primary graft dysfunction occurred in 26.4% of the patients. Multivariable analysis indicated that risk factors for increased infection severity included active VAD-specific infection (OR 4.8; 95% CI 2.3-11.2) and moderate-to-severe primary graft dysfunction (OR 8.8; 95% CI 2.1-42.5) but not duration of CF-VAD support (OR 1.0; 95% CI 1.0-1.0).ConclusionActive VAD-specific infection and poor graft function likely contribute to the severity of early postoperative infections after HTx.Copyright © 2018 Elsevier Inc. All rights reserved.

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