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Left Ventricular Assist Device Infection

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FDG-PET/CT and PET/MR in Cardiovascular Diseases

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Abstract

Left ventricular assist devices (LVADs) improve survival and quality of life for end-stage heart failure patients [1]. Unfortunately, infection is a critical and common complication in patients with LVADs [2]. Diagnosis of LVAD infection in a timely fashion enables the selection and prompt initiation of therapy. However, because of the multiple internal and external components of LVADs, diagnosis and characterization of the extent of infection is particularly challenging. Furthermore, many patients may have other cardiac and extracardiac prosthetic devices. In addition to a comprehensive evaluation including history and physical, cultures, and biomarkers, imaging tests have an important role in the diagnosis of LVAD infections. In particular, FDG-PET/CT has emerged as a powerful imaging technique with high sensitivity and clinical value for diagnosing LVAD infections when added to a thorough clinical evaluation [3]. This chapter will review the epidemiology, and pathophysiology of LVAD infections, present diagnostic strategies, and offer a case-based discussion illustrating the utility of FDG-PET/CT in diagnosing LVAD infections.

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References

  1. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435–43.

    Article  CAS  PubMed  Google Scholar 

  2. Califano S, Pagani FD, Malani PN. Left ventricular assist device-associated infections. Infect Dis Clin North Am. 2012;26(1):77–87.

    Article  PubMed  Google Scholar 

  3. Tam MC, Patel VN, Weinberg RL, Hulten EA, Aaronson KD, Pagani FD, et al. Diagnostic accuracy of FDG PET/CT in suspected LVAD infections: a case series, systematic review, and meta-analysis. JACC Cardiovasc Imaging. 2020;13(5):1191–202.

    Article  PubMed  Google Scholar 

  4. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743.

    Article  PubMed  Google Scholar 

  5. Molina EJ, Shah P, Kiernan MS, Cornwell WK, Copeland H, Takeda K, et al. The Society of Thoracic Surgeons Intermacs 2020 Annual Report. Ann Thorac Surg. 2021;111(3):778–92.

    Article  PubMed  Google Scholar 

  6. Frazier OH, Rose EA, McCarthy P, Burton NA, Tector A, Levin H, et al. Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system. Ann Surg. 1995;222(3):327–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kilic A, Acker MA, Atluri P. Dealing with surgical left ventricular assist device complications. J Thorac Dis. 2015;7(12):2158–64.

    PubMed  PubMed Central  Google Scholar 

  8. Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, et al. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant. 2011;30(4):375–84.

    Article  PubMed  Google Scholar 

  9. Kirklin JK, Naftel DC, Kormos RL, Pagani FD, Myers SL, Stevenson LW, 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;33(1):12–22.

    Article  PubMed  Google Scholar 

  10. Trachtenberg BH, Cordero-Reyes A, Elias B, Loebe M. A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist Debakey Cardiovasc J. 2015;11(1):28–32.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Raymond AL, Kfoury AG, Bishop CJ, Davis ES, Goebel KM, Stoker S, et al. Obesity and left ventricular assist device driveline exit site infection. ASAIO J. 2010;56(1):57–60.

    Article  PubMed  Google Scholar 

  12. Zahr F, Genovese E, Mathier M, Shullo M, Lockard K, Zomak R, et al. Obese patients and mechanical circulatory support: weight loss, adverse events, and outcomes. Ann Thorac Surg. 2011;92(4):1420–6.

    Article  PubMed  Google Scholar 

  13. Clerkin KJ, Naka Y, Mancini DM, Colombo PC, Topkara VK. the impact of obesity on patients bridged to transplantation with continuous-flow left ventricular assist devices. JACC Heart Fail. 2016;4(10):761–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bejko J, Toto F, Gregori D, Gerosa G, Bottio T. Left ventricle assist devices and driveline’s infection incidence: a single-centre experience. J Artif Organs. 2018;21(1):52–60.

    Article  PubMed  Google Scholar 

  15. Goldstein DJ, Naftel D, Holman W, Bellumkonda L, Pamboukian SV, Pagani FD, et al. Continuous-flow devices and percutaneous site infections: clinical outcomes. J Heart Lung Transplant. 2012;31(11):1151–7.

    Article  PubMed  Google Scholar 

  16. Zierer A, Melby SJ, Voeller RK, Guthrie TJ, Ewald GA, Shelton K, et al. Late-onset driveline infections: the Achilles’ heel of prolonged left ventricular assist device support. Ann Thorac Surg. 2007;84(2):515–20.

    Article  PubMed  Google Scholar 

  17. Sharma V, Deo SV, Stulak JM, Durham LA 3rd, Daly RC, Park SJ, et al. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg. 2012;94(5):1381–6.

    Article  PubMed  Google Scholar 

  18. Cagliostro B, Levin AP, Fried J, Stewart S, Parkis G, Mody KP, et al. Continuous-flow left ventricular assist devices and usefulness of a standardized strategy to reduce drive-line infections. J Heart Lung Transplant. 2016;35(1):108–14.

    Article  PubMed  Google Scholar 

  19. Menon AK, Baranski SK, Unterkofler J, Autschbach R, Moza AK, Goetzenich A, et al. Special treatment and wound care of the driveline exit site after left ventricular assist device implantation. Thorac Cardiovasc Surg. 2015;63(8):670–4.

    Article  PubMed  Google Scholar 

  20. Schibilsky D, Benk C, Haller C, Berchtold-Herz M, Siepe M, Beyersdorf F, et al. Double tunnel technique for the LVAD driveline: improved management regarding driveline infections. J Artif Organs. 2012;15(1):44–8.

    Article  PubMed  Google Scholar 

  21. Fleissner F, Avsar M, Malehsa D, Strueber M, Haverich A, Schmitto JD. Reduction of driveline infections through doubled driveline tunneling of left ventricular assist devices. Artif Organs. 2013;37(1):102–7.

    Article  PubMed  Google Scholar 

  22. Wert L, Hanke JS, Dogan G, Ricklefs M, Fleissner F, Chatterjee A, et al. Reduction of driveline infections through doubled driveline tunneling of left ventricular assist devices-5-year follow-up. J Thorac Dis. 2018;10(Suppl 15):S1703–S10.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Singh A, Russo MJ, Valeroso TB, Anderson AS, Rich JD, Jeevanandam V, et al. Modified HeartMate II driveline externalization technique significantly decreases incidence of infection and improves long-term survival. ASAIO J. 2014;60(6):613–6.

    Article  PubMed  Google Scholar 

  24. Dean D, Kallel F, Ewald GA, Tatooles A, Sheridan BC, Brewer RJ, et al. Reduction in driveline infection rates: results from the HeartMate II Multicenter Driveline Silicone Skin Interface (SSI) Registry. J Heart Lung Transplant. 2015;34(6):781–9.

    Article  PubMed  Google Scholar 

  25. Zinoviev R, Lippincott CK, Keller SC, Gilotra NA. In full flow: left ventricular assist device infections in the modern era. open forum. Infect Dis. 2020;7(5):ofaa124.

    Google Scholar 

  26. Nienaber JJ, Kusne S, Riaz T, Walker RC, Baddour LM, Wright AJ, et al. Clinical manifestations and management of left ventricular assist device-associated infections. Clin Infect Dis. 2013;57(10):1438–48.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kusne S, Mooney M, Danziger-Isakov L, Kaan A, Lund LH, Lyster H, et al. An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Heart Lung Transplant. 2017;36(10):1137–53.

    Article  PubMed  Google Scholar 

  28. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–8.

    Article  CAS  PubMed  Google Scholar 

  29. Topkara VK, Kondareddy S, Malik F, Wang IW, Mann DL, Ewald GA, et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg. 2010;90(4):1270–7.

    Article  PubMed  Google Scholar 

  30. Tong MZ, Smedira NG, Soltesz EG, Starling RC, Koval CE, Porepa L, et al. Outcomes of heart transplant after left ventricular assist device specific and related infection. Ann Thorac Surg. 2015;100(4):1292–7.

    Article  PubMed  Google Scholar 

  31. Pieri M, Müller M, Scandroglio AM, Pergantis P, Kretzschmar A, Kaufmann F, et al. surgical treatment of mediastinitis with omentoplasty in ventricular assist device patients: report of referral center experience. ASAIO J. 2016;62(6):666–70.

    Article  PubMed  Google Scholar 

  32. Gordon RJ, Weinberg AD, Pagani FD, Slaughter MS, Pappas PS, Naka Y, et al. Prospective, multicenter study of ventricular assist device infections. Circulation. 2013;127(6):691–702.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Martin SI, Wellington L, Stevenson KB, Mangino JE, Sai-Sudhakar CB, Firstenberg MS, 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(1):20–3.

    Article  PubMed  Google Scholar 

  34. Schulman AR, Martens TP, Christos PJ, Russo MJ, Comas GM, Cheema FH, et al. Comparisons of infection complications between continuous flow and pulsatile flow left ventricular assist devices. J Thorac Cardiovasc Surg. 2007;133(3):841–2.

    Article  PubMed  Google Scholar 

  35. Aaronson KD, Slaughter MS, McGee E, Cotts WG, Acker MA, Jessup ML. Evaluation of the HeartWare HVAD left ventricular assist device system for the treatment of advanced heart failure: results of the advance bridge to transplant trial. Circulation. 2010;122:2215–26.

    Google Scholar 

  36. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32(2):157–87.

    Article  PubMed  Google Scholar 

  37. Hernandez GA, Breton JDN, Chaparro SV. Driveline infection in ventricular assist devices and its implication in the present era of destination therapy. Open J Cardiovasc Surg. 2017;9:1179065217714216.

    PubMed  PubMed Central  Google Scholar 

  38. Erba PA, Pizzi MN, Roque A, Salaun E, Lancellotti P, Tornos P, et al. Multimodality imaging in infective endocarditis: an imaging team within the endocarditis team. Circulation. 2019;140(21):1753–65.

    Article  PubMed  Google Scholar 

  39. Habets J, Tanis W, Reitsma JB, van den Brink RBA, Mali WPTM, Chamuleau SAJ, et al. Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? a systematic review and meta-analysis. Eur Radiol. 2015;25(7):2125–33.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wang TKM, Sánchez-Nadales A, Igbinomwanhia E, Cremer P, Griffin B, Xu B. Diagnosis of infective endocarditis by subtype using (18)f-fluorodeoxyglucose positron emission tomography/computed tomography: a contemporary meta-analysis. Circ Cardiovasc Imaging. 2020;13(6):e010600.

    Google Scholar 

  41. Osborne MT, Hulten EA, Murthy VL, Skali H, Taqueti VR, Dorbala S, et al. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol. 2017;24(1):86–99.

    Article  PubMed  Google Scholar 

  42. Chareonthaitawee P, Beanlands RS, Chen W, Dorbala S, Miller EJ, Murthy VL, et al. Joint SNMMI–ASNC expert consensus document on the role of & 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring. J Nucl Med. 2017;58(8):1341.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Osborne M, Hulten E, Murthy V, Skali H, Taqueti V, Dorbala S, et al. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol. 2016;24:86–99.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kim J, Feller ED, Chen W, Liang Y, Dilsizian V. FDG PET/CT for early detection and localization of left ventricular assist device infection: impact on Patient management and outcome. JACC Cardiovasc Imaging. 2019;12(4):722–9.

    Article  CAS  PubMed  Google Scholar 

  45. Orvin K, Goldberg E, Bernstine H, Groshar D, Sagie A, Kornowski R, et al. The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis. Clin Microbiol Infect. 2015;21(1):69–76.

    Article  CAS  PubMed  Google Scholar 

  46. Pizzi MN, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H, Ferreira-González I, Gonzàlez-Alujas MT, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18f-fluordeoxyglucose positron emission tomography/computed tomography angiography: initial results at an infective endocarditis referral center. Circulation. 2015;132(12):1113–26.

    Article  PubMed  Google Scholar 

  47. Büther F, Stegger L, Dawood M, Range F, Schäfers M, Fischbach R, et al. Effective methods to correct contrast agent-induced errors in PET quantification in cardiac PET/CT. J Nucl Med. 2007;48(7):1060–8.

    Article  PubMed  Google Scholar 

  48. Roque A, Pizzi MN, Fernández-Hidalgo N, Permanyer E, Cuellar-Calabria H, Romero-Farina G, et al. Morpho-metabolic post-surgical patterns of non-infected prosthetic heart valves by [18F]FDG PET/CTA: “normality” is a possible diagnosis. Eur Heart J Cardiovasc Imaging. 2020;21(1):24–33.

    Article  PubMed  Google Scholar 

  49. Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the postoperative period: utility, expected findings, complications, and pitfalls. Semin Nucl Med. 2017;47(6):579–94.

    Article  PubMed  Google Scholar 

  50. Kircher M, Lapa C. Novel noninvasive nuclear medicine imaging techniques for cardiac inflammation. Curr Cardiovasc Imaging Rep. 2017;10(2):6.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ruiz-Zafra J, Rodriguez-Fernandez A, Sanchez-Palencia A, Cueto A. Surgical adhesive may cause false positives in integrated positron emission tomography and computed tomography after lung cancer resection. Eur J Cardiothorac Surg. 2013;43(6):1251–3.

    Article  PubMed  Google Scholar 

  52. Sureshbabu W, Mawlawi O. PET/CT imaging artifacts. J Nucl Med Technol. 2005;33(3):156–61; quiz 63-4.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA

    Chaitanya Madamanchi, Marty Tam & Venkatesh L. Murthy

  2. Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA

    Sami El-Dalati

  3. Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Richard L. Weinberg

Authors
  1. Chaitanya Madamanchi
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  2. Sami El-Dalati
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  3. Marty Tam
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  4. Venkatesh L. Murthy
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  5. Richard L. Weinberg
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Correspondence to Richard L. Weinberg .

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Editors and Affiliations

  1. Montreal Heart Institute, Montréal, QC, Canada

    Matthieu Pelletier-Galarneau

  2. BC Cancer Agency, Vancouver, BC, Canada

    Patrick Martineau

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Madamanchi, C., El-Dalati, S., Tam, M., Murthy, V.L., Weinberg, R.L. (2022). Left Ventricular Assist Device Infection. In: Pelletier-Galarneau, M., Martineau, P. (eds) FDG-PET/CT and PET/MR in Cardiovascular Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-09807-9_16

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  • DOI: https://doi.org/10.1007/978-3-031-09807-9_16

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