2015 DEPARTMENT OF MEDICINE RESEARCH DAY
Title of Poster: Infections Following Total Artificial Heart Placement
Presenter: Jonathan Baghdadi
Division: Infectious Diseases
☐Faculty ☒Fellow ☐Resident ☐Post-doc Research Fellow ☐Graduate Student ☐Medical Student ☐Other
Principal Investigator/Mentor: Bernard Kubak
Kelesidis, Margrit Carlson, Christopher Tymchuk
Co-Investigators: Joanna Schaenman, Jordan Lake, Theodoros
Thematic Poster Category: Infections, Injury and Repair, Inflammation, Host Defense, Immunology, Hemostasis and
Atherosclerosis
Abstract
Background: The Syncardia total artificial heart (TAH) provides biventricular replacement and is
being used with increasing frequency as a bridge to orthotopic heart transplant (OHT). Immunologic
changes after ventricular assist device placement have been described and may alter the risk of
infections.
Methods: Seven adult cases since 2012 were reviewed to explore infections in the setting of TAH.
Infections were defined as a positive culture or new physical finding. Due to widespread abnormalities
on chest imaging, pneumonias were excluded in the absence of a documented pathogen.
Results: Mean age was 46.3. Six of seven cases were male. Indications for TAH included cardiac
allograft vasculopathy and rejection (n=3) and ischemic & non-ischemic cardiomyopathy (n=4).
Infection incidence was 85.7%, with a mean time to first infection of 59 days after TAH placement
(range 12 – 112 days). Three cases developed >1 infection and 3 cases had a single infection. All
patients received broad-spectrum antibiotics at the time of TAH placement. Five cases survived to OHT
and one is awaiting OHT. One case suffered embolic strokes at days 11 and 43 after TAH and died.
Age/Sex
Infections (days after TAH)
Outcome
Awaiting OHT
1
28/M
Influenza A pneumonia (67)
Respiratory syncytial virus bronchitis (471)
Superficial thrombophlebitis (471)
Geotrichum species gastroenteritis (638)
Klebsiella pneumoniae pneumonia (644)
2
35/M
Streptococcus viridans bacteremia (112)
OHT
3
38/M
Candida kruseii fungemia (12)
Klebsiella pneumoniae urinary tract infection (UTI) (12)
Escherichia coli and Klebsiella pneumoniae UTI (77)
Candida kruseii and Candida glabrata mediastinitis (100)
OHT
4
44/F
None
OHT
5
56/M
Clostridium difficile colitis (46)
OHT
6
61/M
Aspergillus ustus drive-line site infection (71)
OHT
7
62/M
Candida parapsilosis fungemia (49)
Achromobacter xylosoxidans UTI (187)
Death
Conclusion: Persons who are TAH-dependent are at risk for the development of diverse infections,
including both community-acquired and nosocomial pathogens. As opposed to the localized drive-line
and pocket site infections seen with other ventricular assist devices, TAH-dependent persons
developed infections at multiple sites. Controlled studies are needed as well as further investigation
into the immunologic impact of device implantation.