174. Temporizing Surgical Measures for Deep Mechanical Circulatory Support Device Infections: Case Series Report

BACKGROUND: Durable mechanical circulatory support device (MCSD) use continues to grow. MCSD deep-seated infections are a serious complication. Removal of the infected hardware is not always possible. METHODS: Single institution retrospective review of all culture-proven deep MCSD infection (pump and/or driveline) from 2009–2019. Patients were managed with intravenous (IV) and oral (PO) antibiotics; definitive surgical interventions included incision and drainage (I&D), device replacement, and heart transplant; and temporizing surgical measures were chronic chest tube (CCT) drainage for pump pocket and mediastinum and antibiotic impregnated bead implantation for driveline infection. Outcomes were analyzed. RESULTS: Total of 29 patients identified, 23 (79%) were male. Median age at device implantation was 44 years (20–68). MCSD were 18 (62%) destination therapy and 11 (38%) bridge to transplant. MCSD included 1 Heartmate I, 17 Heartmate II, 1 Heartmate III, 4 Heartware HVAD, and 6 Syncardia TAH. The median time to infection of 258 days (43–1551), affecting pump in 8 (28%), pump + driveline in 13 (44%), and driveline in 8 (28%). Microorganisms were S. aureus in 17 (60%, MRSA 11 and MSSA 6); coag-negative staphylococci in 3 (10%); Viridans streptococci in 1; Serratia marcescens in 3; P. aeruginosa in 2; Klebsiella oxytoca in 1; Mycobacterium abscessus in 1 and C. albicans in 1. Antibiotics are given to 28 patients, 23 (80%) with initial IV for a median of 6 weeks (1–14) and 5 (17%) with initial PO, for a median of 7 weeks (2–20). Nineteen patients (83%) on IV received PO antibiotics after. 17 patients (61%) remained on chronic suppression antibiotics (13 PO, 2 IV, 2 PO and IV). Twenty-six (90%) patients had I&D, 6 (21%) had device replacement and 11 (38%) had transplant. Of 21 patients with pump infection 16 (76%) had CCT drainage of pump pocket site or mediastinum for a median of 116 days (range 10–887 days). Of 21 patients with driveline infections, 6 (29%) had antibiotic impregnated bead implants. Overall survival at 90 days was 28/29 (95%) and 24/29 (83%) at 1 year. Infection-related mortality in Table 1. CONCLUSION: Deep MCSD infection remains a challenging clinical problem. CCT drainage (for pump) and antibiotic-impregnated bead implant (for driveline) may be temporizing options for patients unable to undergo timely device replacement or heart transplant. [Image: see text] DISCLOSURES: All authors: No reported disclosures.