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Review
. 2020 Apr 17;7(5):ofaa124.
doi: 10.1093/ofid/ofaa124. eCollection 2020 May.

In Full Flow: Left Ventricular Assist Device Infections in the Modern Era

Radoslav Zinoviev  1 , Christopher K Lippincott  2 , Sara C Keller  2 , Nisha A Gilotra  3
Affiliations
Review

In Full Flow: Left Ventricular Assist Device Infections in the Modern Era

Radoslav Zinoviev et al. Open Forum Infect Dis. .

Abstract

With the rising prevalence of heart disease in the United States, there is increasing reliance on durable mechanical circulatory support (MCS) to treat patients with end-stage heart failure. Left ventricular assist devices (LVADs), the most common form of durable MCS, are implanted mechanical pumps that connect to an external power source through a transcutaneous driveline. First-generation LVADs were bulky, pulsatile pumps that were frequently complicated by infection. Second-generation LVADs have an improved design, though infection remains a common and serious complication due to the inherent nature of implanted MCS. Infections can affect any component of the LVAD, with driveline infections being the most common. LVAD infections carry significant morbidity and mortality for LVAD patients. Therefore, it is paramount for the multidisciplinary team of clinicians caring for these patients to be familiar with this complication. We review the epidemiology, prevention, diagnosis, treatment, and outcomes of LVAD infections.

Keywords: cardiac device infection; driveline infection; left ventricular assist device.

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Figures

Figure 1.
Figure 1.
Left ventricular assist device approval timeline. Each generation LVAD device is described, with examples of the devices most used, now or previously, in the United States. Abbreviations: BTT, bridge to transplant; DT, destination therapy; LVAD, left ventricular assist device.
Figure 2.
Figure 2.
Most frequently encountered LVADs currently in use in the United States: (A) HeartMate II, (B) HeartMate III, and (C) HeartWare HVAD. Images of HeartMate 2 and HeartMate 3 are reproduced with permission from Abbott. Image of HeartWare is reproduced with permission from Medtronic, Inc.
Figure 3.
Figure 3.
Potential infection sources in a patient with heart failure and left ventricular assist device, with component and range of reported infection incidence indicated.
See this image and copyright information in PMC

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