Impact of Perioperative Dysphagia and Oral Microbiome on Postoperative Pneumonia after LVAD

PurposePneumonia (PNA) is a frequent complication following left ventricular assist device (LVAD), contributing to prolonged intubation, length of stay and poor quality of life. Dysphagia and poor oral health (dysregulation in oral microbiome) are risk factors for post-op PNA.MethodsWe retrospectively reviewed LVAD patients implanted 1/2015-10/2018. Dysphagia was diagnosed by speech language pathology (SLP) evaluation during the index hospitalization. Biomarkers of immunoregulation (IL-10), inflammation (CRP, IL6, adiponectin), and endotoxemia (soluble CD14) were measured in plasma/serum (n=80) and saliva samples (n=47) were analyzed using 16S rRNA sequencing. Saliva alpha diversity was assessed via Shannon Index (SI).Results254 patients were included; 74 (29%) had SLP evaluations and 180 (71%) did not. In the SLP group, 15 (20%) had no dysphagia and 59 (80%) had dysphagia. Baseline characteristics, biomarkers, and pre-LVAD saliva SI are reported in the Table. The dysphagia group was more likely to have post-op PNA (dysphagia: 23 [39%], no dysphagia: 4 [27%], no evaluation 26 [14%], p<0.001), predominantly with Gram negative bacteria (Figure 1A). Patients with lowest pre-LVAD saliva SI (least diversity) had the highest rates of post-op PNA, irrespective of dysphagia status (OR for PNA per 1-unit decrease in SI [less diverse]: 2.53 [95% CI 0.93-6.86]; p=0.07), and no patients in the highest (more diverse) quartile of saliva SI had post-op PNA (Figure 1B).ConclusionPresence of perioperative dysphagia is associated with higher rates of post-LVAD PNA, while more diverse oral microbiome might confer protection. Pneumonia (PNA) is a frequent complication following left ventricular assist device (LVAD), contributing to prolonged intubation, length of stay and poor quality of life. Dysphagia and poor oral health (dysregulation in oral microbiome) are risk factors for post-op PNA. We retrospectively reviewed LVAD patients implanted 1/2015-10/2018. Dysphagia was diagnosed by speech language pathology (SLP) evaluation during the index hospitalization. Biomarkers of immunoregulation (IL-10), inflammation (CRP, IL6, adiponectin), and endotoxemia (soluble CD14) were measured in plasma/serum (n=80) and saliva samples (n=47) were analyzed using 16S rRNA sequencing. Saliva alpha diversity was assessed via Shannon Index (SI). 254 patients were included; 74 (29%) had SLP evaluations and 180 (71%) did not. In the SLP group, 15 (20%) had no dysphagia and 59 (80%) had dysphagia. Baseline characteristics, biomarkers, and pre-LVAD saliva SI are reported in the Table. The dysphagia group was more likely to have post-op PNA (dysphagia: 23 [39%], no dysphagia: 4 [27%], no evaluation 26 [14%], p<0.001), predominantly with Gram negative bacteria (Figure 1A). Patients with lowest pre-LVAD saliva SI (least diversity) had the highest rates of post-op PNA, irrespective of dysphagia status (OR for PNA per 1-unit decrease in SI [less diverse]: 2.53 [95% CI 0.93-6.86]; p=0.07), and no patients in the highest (more diverse) quartile of saliva SI had post-op PNA (Figure 1B). Presence of perioperative dysphagia is associated with higher rates of post-LVAD PNA, while more diverse oral microbiome might confer protection.