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Review
. 2015 Jan-Mar;11(1):28-32.
doi: 10.14797/mdcj-11-1-28.

A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management

Barry H Trachtenberg  1 , Andrea Cordero-Reyes  1 , Barbara Elias  1 , Matthias Loebe  1
Affiliations
Review

A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management

Barry H Trachtenberg et al. Methodist Debakey Cardiovasc J. 2015 Jan-Mar.

Abstract

Since the advent of ventricular assist devices with smaller configurations and continuous-flow technology, survival rates for patients with end-stage heart failure have dramatically improved. While the burden of infectious complications is decreased in patients on continuous-flow ventricular assist devices compared to bulkier pulsatile-flow devices, infection remains one of the most common causes of morbidity and mortality. The majority of infections occur at the driveline exit site, beginning with a disruption or trauma to the barrier between the skin and driveline and sometimes spreading deeper. Once infections develop, they can be difficult to eradicate. Depending on the degree of infection, treatment options may include local wound care, antibiotics, or surgical treatment. Preventive strategies and careful surveillance are crucial to improve patient outcomes.

Keywords: driveline; infection; left ventricular assist device.

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Figures

None
B. H. Trachtenberg, M.D.
Figure 1.
Figure 1.
Figure shows INTERMACS report on cause of death of patients supported with LVADs; infection becomes the leading cause of mortality, along with neurological events, at 48 months post-implant.
Figure 2.
Figure 2.
Modified from the International Society for Heart and Lung Transplantation working formulation for the standardization of definitions of infections in patients using ventricular assist devices. VAD: ventricular assist device; CVC: central venous catheter; BSI: blood stream infection; SSI: surgical site infection.
Figure 3.
Figure 3.
Modified from the International Society for Heart and Lung Transplantation working formulation for the standardization of definitions of infections in patients using ventricular assist devices. VAD: ventricular assist device; TEE: transesophageal echocardiogram; TTE: transthoracic echocardiogram; CT: contrast tomography; KOH: potassium hydroxide.
Figure 4.
Figure 4.
Example of an anchoring device that is used to stabilize driveline and help prevent infections.
Figure 5.
Figure 5.
Example of driveline infection and the subsequent surgical treatment with beads and retunneling of driveline.
See this image and copyright information in PMC

References

    1. Slaughter MS, Rogers JG, Milano CA et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009 Dec 3;361(23):2241–51. - PubMed
    1. Kirklin JK, Naftel DC, Kormos RL et al. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2014 Jan;33(1):12–22. - PubMed
    1. Patel CB, Cowger JA, Zuckermann A. A contemporary review of mechanical circulatory support. J Heart Lung Transplant. 2014 Jul;33(7):667–74. - PubMed
    1. Smedira NG, Hoercher KJ, Lima B et al. Unplanned hospital readmissions after HeartMate II implantation: frequency, risk factors, and impact on resource use and survival. JACC Heart Fail. 2013 Feb;1(1):31–9. - PubMed
    1. Goldstein DJ, Naftel D, Holman W et al. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transplant. 2012 Nov;31(11):1151–7. - PubMed