Infections in patients after Berlin Heart® EXCOR assist device implantation

Objectives Berlin Heart® EXCOR devices (BHED) are ventricular assist devices (VAD) used mainly as a bridge to heart transplantation (HT) in pediatric population. The aim of our study is to report the infections diagnosed in adult patients undergoing a BHED implantation. Methods Adult patients receiving a BHED between Jul 2009 and Oct 2017 at our institution were included. Infections were classified according to the International Society of Heart and Lung Transplantation definitions in VAD‐Specific (VAD‐S), VAD‐Related (VAD‐R) and non‐VAD (N‐VAD). Results Fifteen patients underwent BHED implantation, which was maintained for a mean of 92 (19‐195) days. Infection occurred in 13 patients who developed 36 infectious episodes: 5 VAD‐S (5 cannula infections); 8 VAD‐R (5 bloodstream infections and 3 mediastinitis) and 24 N‐VAD (7 urinary tract infections, 6 Cytomegalovirus diseases and others). Overall, 27 (75%) were bacterial, 7 (19.4%) were viral and there was one (2.7%) fungal infection. Eleven patients underwent HT and all of them developed at least one infection after it. In 3 cases, all VAD‐R or VAD‐S infections were caused by the same etiology as before HT. Their median time of appearance was on day +6 (3‐11) after BHED removal and HT. Overall mortality was 6/15 (40%). None of the deaths were related to VAD Infection. Conclusions Infection complicated BHED implantation in 86.7% of the patients. Overall, 13.9% were specific of BHED and 22.2% were related. However, infections did not preclude HT in any case and carried no attributable mortality.