P-52. Hazard before the hardware? Bloodstream infections prior to implantation of durable left ventricular assist devices (LVAD)

Abstract Background Implantable mechanical circulatory support (MCS), such as left ventricular assist devices (LVADs), can improve survival in patients with end-stage heart failure. While post-implant complications including MCS-specific infections are well recognized, the outcomes of LVAD recipients with bloodstream infection (BSI) prior to device implantation have not been systemically studied. Methods We performed a single center retrospective study of all consecutive persons who received a Heartmate 3 (HM3) LVAD implanted at our institution between 1/1/17-12/31/23. We compared recipients with and without clinically significant BSI in the three months preceding device implantation. For these two groups, we also compared demographics, clinical characteristics, and outcomes, including post-implant BSI and one-year survival. Results Over the seven-year period, 498 patients received a HM3, of whom 31 (6%) had a pre-implant BSI (Table 1). The median time from pre-implant BSI to LVAD surgery was 13 days (interquartile range 6-18). The most common pathogens were Gram-positive organisms (22; 71%; Figure 1). Patients with pre-implant BSI were younger (p=.007), had lower Elixhauser co-morbidity indices (p=.004), and were in hospital longer immediately prior to LVAD surgery (p< .001) compared to patients without pre-implant BSI. Cumulative incidence of one-year post-implant BSI was similar in those with and without pre-implant BSI (16% v. 13%; p=.596). Of 31 patients with pre-implant BSI, 11 (35%) developed post-implant MCS-specific infection in the first year (n=9 percutaneous lead infections, n=1 device-specific BSI, n=1 infection of external surfaces of implant). Only one (3%) MCS-specific infection was attributed to the same pathogen (S. aureus) isolated in blood culture prior to implant. Patients with pre-implant BSI had longer index hospitalizations after LVAD implantation (47 v. 29 days; p< .001) but similar one-year survival compared to patients without pre-implant BSI (84% v. 81%; p=.707; Figure 2). Conclusion Pre-implant BSI in LVAD recipients was not associated with post-implant BSI. One-year survival was similar between LVAD recipients with and without pre-implant BSI. The risk factors, management, and outcomes of pre-implant BSI in LVAD recipients warrant further study. Disclosures Madeleine R. Heldman, MD, MS, Karius, Inc: Advisor/Consultant Cameron Wolfe, MBBS, Brio-VAD: Advisor/Consultant