Abstract
Cardiac assist devices have emerged as an increasingly important option for circulatory support in patients with advanced congestive heart failure. Infection has been the leading cause of death with use of ventricular assist devices for the past 25 years, and continues to be a major cause of morbidity and mortality in this population. Infections may involve the internal (blood-containing) components, or occur on the external device surfaces. The pump pocket and the percutaneous driveline are particularly vulnerable. In this article we review the pathogenesis, epidemiology, clinical course, and approaches for treatment and prevention of cardiac assist device infections.
Similar content being viewed by others
References and Recommended Reading
Miller LW, Pagani FD, Russell SD, et al.: Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 2007, 357:885–896.
Rose EA, Gelijns AC, Moskowitz AJ, et al.: Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 2001, 345:1435–1443.
Simon D, Fischer S, Grossman A, et al.: Left ventricular assist device-related infection: treatment and outcome. Clin Infect Dis 2005, 40:1108–1115.
Oz MC, Gelijns AC, Miller L, et al.: Left ventricular assist devices as permanent heart failure therapy: the price of progress. Ann Surg 2003, 238:577–583; discussion 583–585.
Monkowski DH, Axelrod P, Fekete T, et al.: Infections associated with ventricular assist devices: epidemiology and effect on prognosis after transplantation. Transpl Infect Dis 2007, 9:114–120.
Shoham S, Shaffer R, Sweet L, et al.: Candidemia in patients with ventricular assist devices. Clin Infect Dis 2007, 44:e9–12.
Zierer A, Melby SJ, Voeller RK, et al.: Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg 2007, 84:515–20.
Arrecubieta C, Asai T, Bayern M, et al.: The role of Staphylococcus aureus adhesins in the pathogenesis of ventricular assist device-related infections. J Infect Dis 2006, 193:1109–1119.
Asai T, Lee MH, Arrecubieta C, et al.: Cellular coating of the left ventricular assist device textured polyurethane membrane reduces adhesion of Staphylococcus aureus. J Thorac Cardiovasc Surg 2007, 133:1147–1153.
Padera RF: Infection in ventricular assist devices: the role of biofilm. Cardiovasc Pathol 2006, 15:264–270.
Kimball PM, Flattery M, McDougan F, Kasirajan V. Cellular immunity impaired among patients on left ventricular assist device for 6 months. Ann Thorac Surg 2008, 85:1656–1661.
Kimball P, Flattery M, Kasirajan V: T-cell response to staphylococcal enterotoxin B is reduced among heart failure patients on ventricular device support. Transplant Proc 2006, 38:3695–3696.
Yamani MH, Chuang HH, Ozduran V, et al.: The impact of hypogammaglobulinemia on infection outcome in patients undergoing ventricular assist device implantation. J Heart Lung Transplant 2006, 25:820–824.
Gonzalez-Stawinski GV, Cook DJ, Chang AS, et al.: Ventricular assist devices and aggressive immunosuppression: looking beyond overall survival. J Heart Lung Transplant 2006, 25:613–618.
Schulman AR, Martens TP, Christos PJ, et al.: Comparisons of infection complications between continuous flow and pulsatile flow left ventricular assist devices. J Thorac Cardiovasc Surg 2007, 133:841–842.
Shive MS, Salloum ML, Anderson JM: Shear stress-induced apoptosis of adherent neutrophils: a mechanism for persistence of cardiovascular device infections. Proc Natl Acad Sci U S A 2000, 97:6710–6715.
Shive MS, Brodbeck WG, Colton E, Anderson JM: Shear stress and material surface effects on adherent human monocyte apoptosis. J Biomed Mater Res 2002, 60:148–158.
Shive MS, Hasan SM, Anderson JM: Shear stress effects on bacterial adhesion, leukocyte adhesion, and leukocyte oxidative capacity on a polyetherurethane. J Biomed Mater Res 1999, 46:511–519.
Pae WE, Connell JM, Adelowo A, et al.: Does total implantability reduce infection with the use of a left ventricular assist device? The LionHeart experience in Europe. J Heart Lung Transplant 2007, 26:219–229.
Holman WL, Pamboukian SV, Blood M, et al.: Managing device infections: are we progressing or is infection an insurmountable obstacle? Asaio J 2005, 51:452–455.
Holman WL, Rayburn BK, McGiffin DC, et al.: Infection in ventricular assist devices: prevention and treatment. Ann Thorac Surg 2003, 75:S48–S57.
Holman WL, Pamboukian SV, Bellot SC, et al.: Use of an intraperitoneal ventricular assist device with a polytetra-fluoroethylene barrier decreases infections. J Heart Lung Transplant 2008, 27:268–271.
Baradarian S, Stahovich M, Krause S, et al.: Case series: clinical management of persistent mechanical assist device driveline drainage using vacuum-assisted closure therapy. Asaio J 2006, 52:354–356.
Holman WL, Park SJ, Long JW, et al.: Infection in permanent circulatory support: experience from the REMATCH trial. J Heart Lung Transplant 2004, 23:1359–1365.
Huang R, Deng M, Rogers JG, et al.: Effect of age on outcomes after left ventricular assist device placement. Transplant Proc 2006, 38:1496–1498.
Granfeldt H, Hellgren L, Dellgren G, et al.: Experience with the Impella(R) recovery axial-flow system for acute heart failure at three cardiothoracic centers in Sweden. Scand Cardiovasc J 2009:1–7.
El-Hamamsy I, Jacques F, Perrault LP, et al.: Results following implantation of mechanical circulatory support systems: the Montreal Heart Institute experience. Can J Cardiol 2009, 25:107–110.
Osaki S, Edwards NM, Velez M, et al.: Improved survival in patients with ventricular assist device therapy: the University of Wisconsin experience. Eur J Cardiothorac Surg 2008, 34:281–288.
Lietz K, Long JW, Kfoury AG, et al.: Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation 2007, 116:497–505.
Chinn R, Dembitsky W, Eaton L, et al.: Multicenter experience: prevention and management of left ventricular assist device infections. Asaio J 2005, 51:461–470.
Manahan MA, Goldberg NH, Silverman RP. Successful salvage of ventricular-assist devices in the setting of pump pocket infection. Ann Plast Surg 2006, 57:435–439.
Didisheim P, Rose EA, Long JW, et al.: Infection with clinical ventricular assist devices: clinical therapy. Asaio J 2001, 47:195–196.
Yuh DD, Albaugh M, Ullrich S, Conte JV: Treatment of ventricular assist device driveline infection with vacuum-assisted closure system. Ann Thorac Surg 2005, 80:1493–1495.
McGee EC, Jr., Cotts W, Tambur AR, et al.: Successful bridge to transplant in a highly sensitized patient with a complicated pump pocket infection. J Heart Lung Transplant 2008, 27:568–571.
Sajjadian A, Valerio IL, Acurturk O, et al.: Omental transposition flap for salvage of ventricular assist devices. Plast Reconstr Surg 2006, 118:919–926; discussion 927.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shoham, S., Miller, L.W. Cardiac assist device infections. Curr Infect Dis Rep 11, 268–273 (2009). https://doi.org/10.1007/s11908-009-0040-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11908-009-0040-4