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Risks and Epidemiology of Infections Associated with Ventricular Assist Devices and Heart Transplantation

  • Amanda R. Vest
  • David DeNofrio
  • David R. Snydman
Chapter

Abstract

The “gold standard” intervention for refractory systolic heart failure is heart transplantation, which is accompanied by a range of potential bacterial, fungal, viral, and parasitic infectious complications. In recent years, the growth of mechanical circulatory support has brought with it an additional sphere of infectious challenges, both during left ventricular assist device (LVAD) support and also after a successful bridge to heart transplantation. In particular, LVAD patients may experience driveline site infections that require additional management considerations after transplantation. However, the prevalence of infectious complications of heart transplantation has been decreasing overall, in part due to routine prophylaxis against bacterial and viral infections as well as improved intraoperative and critical care management. Cytomegalovirus remains a significant concern after heart transplantation, especially given its association with the development of coronary vasculopathy. There is evolving experience in immune function monitoring, which may enable attainment of a finer balance between the relative risks of infection and graft rejection.

Keywords

Heart failure Cardiac transplantation Left ventricular assist device Bacteremia Fungal infections Cytomegalovirus Hypogammaglobulinemia 

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© Springer International Publishing Switzerland 2016

Open Access This chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  • Amanda R. Vest
    • 1
  • David DeNofrio
    • 1
  • David R. Snydman
    • 2
  1. 1.Division of CardiologyTufts Medical CenterBostonUSA
  2. 2.Division of Geographic Medicine and Infectious DiseasesTufts Medical CenterBostonUSA

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