Current Infectious Disease Reports

, Volume 15, Issue 6, pp 472–477 | Cite as

Infectious Complications of Mechanical Circulatory Support (MCS) Devices

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

Abstract

Left-ventricular assist devices and other forms of mechanical circulatory support are increasingly important in the routine therapy of patients with end-stage congestive heart failure. Technology may help to decrease the rate of infections associated with these devices, but with larger numbers of implants being utilized across the globe, infections overall are becoming more commonplace. Becoming familiar with appropriate techniques for prevention and with the ideal approach to diagnostic and therapeutic strategies is key to managing mechanical circulatory support infections in this unique, but growing, patient population.

Keywords

Cardiac device infection Left ventricular assist devices (LVAD) Driveline infection Mechanical circulatory support (MCS) Heart transplantation 

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Lloyd-Jones D, Adams RJ, et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121:e46.PubMedCrossRefGoogle Scholar
  2. 2.
    Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993;22:6A.PubMedCrossRefGoogle Scholar
  3. 3.
    Colvin-Adams M, Smith JM, Heubner BM, et al. OPTN/SRTR 2011 annual data report: heart. Am J Transplant. 2013;13 Suppl 1:119–48.PubMedCrossRefGoogle Scholar
  4. 4.
    •• Rose EA, Gelijns AC, Moskowitz, for the REMATCH Study Group, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345:1435–43. This was the study that validated the use of LVADs as destination therapy for patients with end-stage CHF and expanded their use throughout the world.PubMedCrossRefGoogle Scholar
  5. 5.
    Holman WL, Park SJ, Long JW, for the REMATCH Investigators, et al. Infection in permanent circulatory support: experience from the REMATCH trial. J Heart Lung Transplant. 2004;23:1359–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Kirklin JK, Naftel DC, Warner Stevenson L, et al. INTERMACS database for durable devices for circulatory support: first annual report. J Heart Lung Transplant. 2008;27:1065–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Holman WL, Kirklin JK, Naftel DC, et al. Infection after implantation of pulsatile mechanical circulatory support devices. J Thorac Cardiovasc Surg. 2010;139:1632–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Kirklin JK, Naftel DC, Kormos RL, et al. Second INTERMACS annual report: more than 1000 primary left ventricular assist device implants. J Heart Lung Transplant. 2010;29:1–10.PubMedCrossRefGoogle Scholar
  9. 9.
    •• Kirklin JK, Naftel DC, Kormos RL, et al. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013;32:141–56. This is the most recent report from INTERMACS detailing the infectious complications of all FDA-approved MCS devices since 2006.PubMedCrossRefGoogle Scholar
  10. 10.
    •• Hannan MM, Husain S, Mattner F, et al. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant. 2011;30:375–84. This report is the Infectious Diseases Working Group consensus statement from the ISHLT on the definitions of LVAD-related infections and represents the most detailed and comprehensive attempt to date on the diagnosis of LVAD infections.PubMedCrossRefGoogle Scholar
  11. 11.
    Simon D, Fischer S, Grossman A, et al. Left ventricular assist device-related infection: treatment and outcome. Clin Infect Dis. 2005;40:1108–15.PubMedCrossRefGoogle Scholar
  12. 12.
    Goldstein DJ, Naftel D, Holman W, et al. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transplant. 2012;31:1151–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.PubMedCrossRefGoogle Scholar
  14. 14.
    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;26:219–29.PubMedCrossRefGoogle Scholar
  15. 15.
    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;9:114–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Myers TJ, Khan T, Frazier OH. Infectious complications associated with ventricular assist systems. ASAIO J. 2000;46:S28–36.PubMedCrossRefGoogle Scholar
  17. 17.
    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;84:515–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Martin SI, Wellington L, Stevenson KB, et al. Effect of body mass index and device type on infection in left ventricular assist device support beyond 30 days. Interact Cardiovasc Thorac Surg. 2010;11:20–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Malani PN, Dyke DBS, Pagani FD, Chenoweth CE. Nosocomial infections in left ventricular assist device recipients. Clin Infect Dis. 2002;34:1295–300.PubMedCrossRefGoogle Scholar
  20. 20.
    Hermann M, Weyand M, Greshake B, et al. Left ventricular assist device infection is associated with increased mortality but is not a contraindication to transplantation. Circulation. 1997;95:814–7.CrossRefGoogle Scholar
  21. 21.
    Deng MC, Loebe M, El-Banayosy A, et al. Mechanical circulatory support for advanced heart failure: effect of patient selection on outcome. Circulation. 2001;103:231–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Toba FA, Akashi H, Arrecubieta C, Lowy FD. Role of biofilm in Staphylococcus aureus and Staphylococcus epidermidis ventricular assist device driveline infections. J Thorac Cardiovasc Surg. 2011;141:1259–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Poston RS, Husain S, Sorce D, et al. LVAD bloodstream infections: therapeutic rationale for transplantation after LVAD infection. J Heart Lung Transplant. 2003;22:914–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Gordon SM, Schmitt SK, Jacobs M, et al. Nosocomial bloodstream infections in patients with implantable left ventricular assist devices. Ann Thorac Surg. 2001;71:614–8.CrossRefGoogle Scholar
  25. 25.
    Sivaratnam K, Duggan JM. Left ventricular assist device infections: three case reports and a review of the literature. ASAIO J. 2002;48:2–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Shoham S, Shaffer R, Sweet L, et al. Candidemia in patients with ventricular assist devices. 2007;44:e9–12.Google Scholar
  27. 27.
    Pappas PG, Kauffman CA, Andes D. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Bagdasarian NG, Malani AN, Pagani FD, Malani PN. Fungemia associated with left ventricular assist device support. J Card Surg. 2009;24:763–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Chinn R, Dembitsky W, Eaton L, et al. Multicenter experience: prevention and management of left ventricular assist device infections. ASAIO J. 2005;51:461–70.PubMedCrossRefGoogle Scholar
  30. 30.
    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;52:354–6.PubMedCrossRefGoogle Scholar
  31. 31.
    McKellar SH, Allred BD, Marks JED, et al. Treatment of infected left ventricular assist device using antibiotic-impregnated beads. Ann Thorac Surg. 1999;67:554–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Matsumiya G, Nishimura M, Miyamoto Y, Sawa Y, Matsuda H. Succesful treatment of Novacor pump pocket infection by omental transposition. Ann Thorac Surg. 2003;75:287–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Baddour LM, Bettmann MA, Bolger AF, et al. Nonvalvular cardiovascular device-related infections. Circulation. 2003;108:2015–31.PubMedCrossRefGoogle Scholar
  34. 34.
    Dembitsky WP, Tector AJ, Park S, et al. Left ventricular assist device performance with long-term circulatory support: lessons from the REMATCH trial. Ann Thorac Surg. 2004;78:2123–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Walker PC, Depestel DD, Miles NA, et al. Surgical infection prophylaxis practices for left ventricular assist device implantation. J Card Surg. 2011;26:440–3.PubMedCrossRefGoogle Scholar
  36. 36.
    Feldman D, Pamboukian SV, Teuteberg, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157–87.PubMedCrossRefGoogle Scholar
  37. 37.
    Perl TM, Cullen JJ, Wenzel RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346:1871–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Healy AH, Baird BC, Drakos SG, Stehlik J, Selzman CH. Impact of ventricular assist device complications on posttransplant survival: an analysis of the United Network of Organ Sharing database. Ann Thorac Surg. 2013;95:870–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Transplant Infectious Diseases Service, Division of Infectious DiseasesThe Ohio State University Wexner Medical CenterColumbusUSA

Personalised recommendations