Although heart transplantation remains the gold standard in the treatment of advanced heart failure, the limited availability of donor organs and the growing number of patients requiring long-term care have necessitated wider implementation of mechanical circulatory support (MCS). Ventricular assist devices (VADs) substantially improve survival and quality of life, yet their clinical use is still constrained by serious complications, most notably local infections at percutaneous exit sites. This challenge persists across all device generations, from extracorporeal pulsatile pumps to contemporary continuous-flow systems. While fourth-generation concepts based on transcutaneous energy transfer are under development, unresolved issues such as thermal tissue injury continue to impede their adoption. This review critically examines current evidence on local infections, with particular emphasis on the role of biomaterials in bacterial colonization. The clinical burden and microbial etiology, dominated by Staphylococcus aureus and Staphylococcus epidermidis, are outlined, together with the limitations of existing material solutions, which lack durable antimicrobial activity. These infections frequently result in tissue necrosis, sepsis, rehospitalization, and elevated treatment costs, and their management is further complicated by the global rise in antimicrobial resistance. By synthesizing available data and identifying key shortcomings of current materials, this review underscores the urgent need for next-generation biomaterials with enhanced biocompatibility, resistance to microbial adhesion, and intrinsic or functionalized antimicrobial activity. Such advances are essential to improve the long-term safety and clinical outcomes of MCS therapy.
Cholewa et al. (Tue,) studied this question.