Association between bacteremia and stroke events in patients with HeartMate 3

Background Bacteremia after implantation of a left ventricular assist device (LVAD) has been reported as a risk factor for subsequent stroke. HeartMate3TM (HM3), a magnetically levitated LVAD, has been shown to reduce the incidence of stroke after implantation. However, the association between bacteremia and subsequent stroke event remains unclear in patients with HM3 implantation. Objective We retrospectively analyzed 136 patients who underwent HM3 implantation between August 2019 and July 2024. 6 patients who experienced a stroke event within 90 days after HM3 implantation were excluded. 130 patients were included in the present study. When multiple stroke events or episodes of bacteremia occurred, only the first event was considered. Bacteremia was defined as positivity in two sets of blood cultures. Patients who developed bacteremia after a stroke event were included in the non-bacteremia group. The mean follow-up duration after HM3 implantation was 2.7 ± 1.6 years. The association between bacteremia and subsequent stroke events was evaluated using the log-rank test and Cox proportional hazards models. Results Bacteremia occurred in 25 patients (19.2 %) at a mean of 0.67 (0.15 – 1.28) years after HM3 implantation. Methicillin-susceptible Staphylococcus aureus was the most frequently identified pathogen, detected in 6 patients (24.0%). Stroke events were observed in 15 patients (11.5 %), including intracerebral hemorrhage in 11 patients (8.5 %) and ischemic stroke in 4 patients (3.1 %). The incidence of stroke events was significantly higher in the bacteremia group (28.0 % vs 7.6 %, p< 0.001). In a univariable Cox proportional hazards analysis, bacteremia after LVAD implantation was significantly associated with an increased risk of stroke events (hazard ratio [HR] 5.94, 95% confidence interval [CI] 2.12–16.66, p = 0.001). In multivariable analysis adjusting for age, sex, bacteremia prior to HM3 implantation, bacteremia after LVAD implantation remained independently associated with an increased risk of stroke events (HR 5.80, 95% CI 2.04 – 16.47, p = 0.001). Conclusion Bacteremia after HM3 implantation may be associated with an increased risk of subsequent stroke events.