VAD Infections Correlated by Preoperative (PET)-CT Scan: Impact on Outcome after Heart Transplantation

Background: Infections are one of the most common complications in patients with a ventricular assist device (VAD) while waiting for heart transplantation (htx). If the infection becomes increasingly uncontrollable, a high urgent status (HU) on the waiting list should be considered. A PET/CT scan or contrast-media-based CT scan may help to estimate the presence and extension of an infection, which can be treated locally or systemically before transplantation. The aim of this study was to analyze the significance of pathologies observed in (PET-)CT scans in patients with a VAD-associated infection and their impact on outcomes after htx.

Methods: Between 09/2010 and 07/2024, 333 patients underwent heart transplantation in our department. Out of these patients, 29 were listed with HU status on waiting list due to an LVAD-associated infection. Among the patients, 26 underwent either a PET-CT scan (n = 10) or a CT scan (n = 16) and these could then be divided into 2 groups based on the presence of an image–morphologic correlate: group 1 showed no pathology in the scan (n = 12), group 2 had a detectable pathology (n = 14). The groups were comparable regarding age, gender, underlying cardiac disease, and cardiac function. Furthermore, donor criteria were comparable between the groups, i.e., gender, CMV status, and left ventricular ejection fraction before organ harvesting.

Results: The average donor age in group 1 was 38 ± 12 years and 42 ± 12 years in group 2 (p > 0.05). Preoperative C-reactive protein was slightly raised in group 1 compared with group 2 (1.2 ± 1.4 mg/dL; 2.7 ± 3.3 mg/dL; p > 0.05). Thirty-day mortality was 8.3% in group 1 and 0% in group 2. One-year survival was 66.7% in group 1 and 90.9% in group 2 (p > 0.05). Duration of mechanical ventilation was significantly prolonged in group 1; additionally, there was a higher need for an extracorporeal support after transplantation (group 1: 58.3%; group 2: 21.4%; p > 0.05). Postoperatively, 41.7% of group 1 and 50.0% of group 2 patients suffered from a bacterial infection after htx. There were no significant differences between the groups regarding postoperative renal failure, rejection, and fungal infections. Neurological symptoms occurred slightly more often in group 2 (p > 0.05).

Conclusion: Altogether, we found acceptable results in patients which were urgently transplanted due to a VAD system infection. Surprisingly, outcome was even slightly better in the group of patients with pathologic findings in the preoperative (PET-)CT scan.

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Artikel online veröffentlicht:
11. Februar 2025