Multicenter Experience: Prevention and Management of Left Ventricular Assist Device Infections

Abstract

Implantable left ventricular assist devices (LVADs) have demonstrated clinical success in both the bridge-to-transplantation and destination-therapy patient populations; however, infection remains one of the most common causes of mortality during mechanical circulatory support. Thus, serious LVAD infections may negate the benefits of LVAD implantation, resulting in decreased quality of life, increased morbidity and mortality, and increased costs associated with implantation. Prevention of device-related infection is crucial to the cost-effective use of mechanical circulatory support devices. Therefore, adherence to evidence-based infection control and prevention guidelines, meticulous surgical technique and optimal postoperative surgical site care form the foundation for LVAD associated infection prevention.

Ventricular Assist Device: Emerging Modality for Long Term Cardiac Support

“…At all times, the driveline must be secured to minimize the risk of trauma; immobilization can be performed with an abdominal binder, additional gauze, tape, or a stoma-adhesive device. 64,65 There are also many modifications made to device design to further decrease the risk of infection which include the use of larger single-lead drivelines and drivelines coated with chlorhexidine and silver sulfadiazine. 60,66 Studies of rotary blood pumps with their reduced surface area for colonization and smaller surgical pump pocket suggest that they are less prone to infection.…”

Ventricular Assist Device-Specific Infections

“…The length of the percutaneous pathway should be maximized (10-12cm) and should enter the muscle within 4-8cm of the VAD. The velour portion of the percutaneous driveline should not extend more than 1-2cm outside the body (Chinn et al, 2005;Slaughter et al, 2010). Some centers have even begun fully implanting the velour portion however this has not yet been supported with any large-scale studies.…”

“…These beads are currently approved for use with chronic osteomyelitis and infected orthopedic implants and their use with VADs is still experimental and requires further research as to optimum size, shape, and positioning of the beads. A potential risk of using these beads is that they may breed more resistant organisms (Chinn et al, 2005;Slaughter et al, 2010). After either percutaneous or surgical incision and drainage, aggressive wound care is critical to successful treatment of an infected VAD pocket.…”

“…The chapter also includes definitions of the various types of VAD-specific infections and outlines a general guideline for the treatment of these different infections. This guide builds upon current literature available on VAD-specific infection (Chinn et al, 2005;Slaughter et al, 2010).…”

ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

“…• Mechanical problems related to the LVAD, valve conduit, right ventricular dysfunction or ischemia, tricuspid regurgitation, aortic regurgitation with shunting of LVAD output, pulmonary vascular resistance, systemic vascular resistance, and patent foramen ovale with hypoxemia 61,62 • Interpretation of LVAD-related hemodynamics based on noninvasive, invasive, and console data • Supraventricular and ventricular arrhythmias pertinent to the device, such as suction events with axial flow devices 63 • Hematological issues, including bleeding and thrombosis associated with antiplatelet and anticoagulant therapy, 64 and device-related hemolysis • Infectious complications 65 This HF specialist should also be knowledgeable in the following areas:…”