LAUSR

Introduction While cytomegalovirus (CMV) reactivation occurs frequently in immunocompetent patients who are critically ill and has been associated with worse outcomes, very few cases of CMV reactivation have been reported following left ventricular assist device (LVAD) implantation. We aimed to evaluate the incidence and risk factors for CMV reactivation following LVAD implantation as well as treatment strategies for these CMV infections. Methods Retrospective chart review of patients of patients who had undergone LVAD implantation between July 2004 and January 2019 was performed. Cases with CMV reactivation post-LVAD were randomly matched by sex, LVAD type, and implant year in a 1:2 fashion with controls utilizing SAS macros. Days-to-reactivation post-implantation were calculated in cases and corresponding times post-implantation were determined in control patients for variable comparisons. Fisher's exact and paired sample t-tests were performed to evaluate for differences between categorical and continuous variables, respectively. Results Of the 349 patients reviewed, 213 (61%) patients were positive for CMV IgG prior to LVAD implantation. Of these 213 patients, 8 (3.8%) patients had CMV reactivation following LVAD implantation. Six (75%) of the 8 patients had CMV viremia, while the other 2 had colitis and pneumonia without evidence of viremia. Full between group comparisons are listed in Figure 1. In comparison to matched controls, patients who had CMV reactivation had a higher creatinine (p=0.039), higher RDW (p=0.05), were more likely to have received steroids within the previous week (p=0.028), and were more likely to have a concurrent bacterial infection (p=0.001). Seven (87.5%) of the 8 patients underwent treatment for their CMV reactivation, with all of them receiving intravenous ganciclovir as initial therapy. The one patient who did not receive treatment had low level viremia and was asymptomatic. Full description of the management of the CMV reactivation cohort is listed in Figure 2. Conclusions CMV reactivation following LVAD implantation is more frequent than previously expected. Awareness of this clinical entity for early testing, diagnosis, and treatment in at risk patients (i.e. renal failure, steroid use, elevated RDW) is important to ensuring good clinical outcomes.