Key result
Device-specific infections in patients with ventricular assist devices occur at a persistent rate of 0.16 events per patient-year in both early and late postimplantation periods.
Why the study?
Despite technologic improvements in mechanical circulatory support, infection remains a leading adverse event following ventricular assist device implantation.
VAD-specific infections, particularly driveline infections, remain a persistent and non-diminishing complication over time, necessitating aggressive treatment and driving the need for fully implantable devices.
Persistent late VAD infection rates highlight need for sustained prevention; leaves open optimal long-term strategies in destination therapy.
Mechanical circulatory support is increasingly being used as bridge-to-transplant and destination therapy in patients with advanced heart failure. Technologic improvements have led to increased patient survival and quality of life, but infection remains one of the leading adverse events following ventricular assist device (VAD) implantation. Infections can be classified as VAD-specific, VAD-related, and non-VAD infections. Risk of VAD-specific infections, such as driveline, pump pocket, and pump infections, remains for the duration of implantation. While adverse events are typically most common early (within 90 days of implantation), device-specific infection (primarily driveline) is a notable exception. No diminishment over time is seen, with event rates of 0.16 events per patient-year in both the early and late periods postimplantation. Management of VAD-specific infections requires aggressive treatment and chronic suppressive antimicrobial therapy is indicated when there is concern for seeding of the device. While surgical intervention/hardware removal is often necessary in prosthesis-related infections, this is not so easily accomplished with VADs. This review outlines the current state of infections in patients supported with VAD therapy and discusses future directions, including possibilities with fully implantable devices and novel approaches to treatment.
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Inglis et al. (2023) conducted a review in Advanced heart failure with left ventricular assist devices. Left Ventricular Assist Devices (VAD) was evaluated. Device-specific infections in patients with ventricular assist devices occur at a persistent rate of 0.16 events per patient-year in both early and late postimplantation periods.
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