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  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)
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Contemporary Management Strategies in VAD Infection

Current Heart Failure Reports volume 17, pages 85–96 (2020)Cite this article

Abstract

Purpose of Review

The use of durable ventricular assist devices (VAD) to manage end-stage heart failure is increasing, but infection remains a leading cause of morbidity and mortality among patients with VAD. In this review, we synthesize recent data pertaining to the epidemiology, diagnosis, management, and prevention of VAD infections, discuss transplant considerations in patients with VAD infections, and highlight remaining knowledge gaps. We also present a conceptual framework for treating clinicians to approach these infections that draws on the same principles that guide the treatment of analogous infections that occur in patients without VAD.

Recent Findings

Despite advances in device design, surgical techniques, and preventative interventions, more than a third of VAD recipients still experience infection as an adverse outcome. Positron emission tomography has emerged as a promising modality for identifying and characterizing VAD infections. High-quality data to support many of the routine therapeutic strategies currently used for VAD infections—including suppressive antibiotic therapy, surgical debridement/device exchange, and novel antimicrobials for emerging multidrug-resistant organisms—remain limited. Although pre-transplant VAD infection may impact some early transplant outcomes, transplantation remains a viable option for patients with most types of VAD infection.

Summary

Standardized definitions of VAD infection applied to large registry datasets have yielded key insights into the epidemiology of infectious complications among VAD recipients, but more prospective studies are needed to evaluate the effectiveness of existing and novel diagnostic and therapeutic strategies.

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Funding

Dr. Phadke was supported in part by Imagine, Innovate and Impact (I3) Funds from the Emory School of Medicine and through the Georgia CTSA NIH award (UL1-TR002378).

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  1. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Varun K. Phadke & Stephanie M. Pouch

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Phadke, V.K., Pouch, S.M. Contemporary Management Strategies in VAD Infection. Curr Heart Fail Rep 17, 85–96 (2020). https://doi.org/10.1007/s11897-020-00459-x

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Keywords

  • Ventricular assist device (VAD) infection
  • Mechanical circulatory (MCS) support
  • Driveline infection
  • VAD endocarditis