Left ventricular assist device-related infections: past, present and future

Maniar, Sanjay; Kondareddy, Sreekanth; Topkara, V.K.

doi:10.1586/erd.11.36

Cited by 70 publications

(49 citation statements)

References 52 publications

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“…It has been proposed that LVAD therapy induces defects in the cellular and humoral immune system, making these individuals more vulnerable to infections. [181920]…”

Section: Discussionmentioning

confidence: 99%

The Role of Computed Tomography in Predicting Left Ventricular Assist Device Infectious Complications

Gomez

Schiffman

Hobbs

2016

Journal of Clinical Imaging Science

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Objective:The purpose of this study is to identify early computed tomography findings around the driveline which would predict mediastinal or left ventricular assist device (LVAD) pocket abscess formation.Materials and Methods:A retrospective analysis was performed on 128 LVAD recipients between January 2007 and December 2011. Infectious complications were subdivided into those affecting the driveline and those resulting in abscess formation either around the LVAD pump or mediastinum. The size and location of infiltrative changes surrounding the driveline were used to predict infection propagation resulting in abscess.Results:Of the 128 patients, 49 (38.3%) patients developed driveline infections and 24 (18.8%) patients developed abscess. 87.5% patients who developed abscess had a preceding driveline infection. The mean time from driveline infection to the development of pump pocket abscess was approximately 7 months. In addition, patients with abscess in the pump pocket or mediastinum had preceding infiltrative changes surrounding the driveline ≥14 mm (P = 0.0001). A preperitoneal location and size of infiltrative changes ≥14 mm were correlated with a higher likelihood of abscess formation (P = 0.0002).Conclusion:Our study demonstrates the predictive value of infection/infiltrative changes around the driveline, which increases the risk for abscess formation in the LVAD pump pocket and/or in the mediastinum.

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“…It has been proposed that LVAD therapy induces defects in the cellular and humoral immune system, making these individuals more vulnerable to infections. [181920]…”

Section: Discussionmentioning

confidence: 99%

The Role of Computed Tomography in Predicting Left Ventricular Assist Device Infectious Complications

Gomez

Schiffman

Hobbs

2016

Journal of Clinical Imaging Science

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“…These complications may include driveline infections, pump-pocket infections, or LVAD-associated endocarditis leading to bacteremia and sepsis [1]. LVAD-associated infections are obviously a driving force for increased morbidity, mortality, and hospital costs [2].…”

Section: Discussionmentioning

confidence: 99%

“…espite the advances in the design of LVADs, infectious complications remain an inherent and serious risk to both patients and the healthcare system [1,2,3]. To date, there is no well-defined guideline in the management of such infections.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Bead Therapy for Implantable Left Ventricular Device Pocket Infection

Tatarian¹,

Cavarocchi²,

Hirose³

2015

jcvd

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357  AbstractInfectious complications of left ventricular assist devices (LVAD) are associated with increases in morbidity, mortality, and hospital costs. Traditional treatment options include intravenous antibiotics, operative debridement, and pump exchange. Herein, we report the case of a 70-year-old female who developed a LVAD pocket infection two weeks after implantation and was successfully treated with antibiotic beads within the LVAD pocket, after the failure of traditional therapies. Antibiotic beads may be a useful adjunct in the treatment and salvage of an infected LVAD.

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“…When LVAD driveline or pump pocket infection is suspected, blood cultures with gram stain should be obtained before the initiation of broad-spectrum antibiotic therapy (32). LVAD endocarditis is similar to prosthetic valve endocarditis, which can lead to a series of complications such as LVAD dysfunction, LVAD thrombosis and septic embolization (1,6).…”

Section: Diagnosismentioning

confidence: 99%

“…In addition to systemic antibiotics, driveline infection also requires surgical drainage and incision of the driveline site with driveline revision, which allows for removal of dead tissue for faster recovery. Vacuum-assisted closure devices can also be used in driveline infection (32,37). In the case of pump pocket infection, if there is fluid collection around the device, exploration of the site with surgical incision and drainage is required.…”

Section: Managementmentioning

confidence: 99%