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<h2>Abstract</h2><h3>Objectives</h3><p>The implantable left ventricular assist device (LVAD) is a major therapeutic development for end-stage heart failure in selected patients. As their use is expanding, infectious complications are emerging, with limited data available to guide their management. We aimed to better characterize LVAD-related infections.</p><h3>Methods</h3><p>We enrolled all consecutive patients diagnosed with LVAD-related infections in three referral centres in France, using a standardized definition of infections in patients with LVAD. Data were collected from medical charts using a standardized questionnaire.</p><h3>Results</h3><p>Between 2007 and 2012, 159 patients received LVAD for end-stage heart failure. Among them, 36 (22.6%; 5 women, 31 men) presented at least one infectious complication, after a median time of 2.9 months from LVAD implantation (interquartile range, 1.8–7.5), with a median follow up of 12 months (interquartile range 8–17). Main co-morbidities were alcoholism (33%), diabetes (11%) and immunosuppression (11%). Mean age at implantation was 51 (±11) years. LVAD were implanted as bridge-to-transplantation (<i>n</i>=22), bridge-to-recovery (<i>n</i>=8), destination therapy (<i>n</i>=4), or unspecified (<i>n</i>=2). LVAD-related infections were restricted to the driveline exit site (<i>n</i>=17), had loco-regional extension (<i>n</i>=13), or reached the internal pump (<i>n</i>=3). The main bacteria isolated were <i>Staphylococcus aureus</i> (<i>n</i>=20), coagulase-negative staphylococci (<i>n</i>=7), <i>Enterobacteriaceae</i> (<i>n</i>=14), <i>Pseudomonas aeruginosa</i> (<i>n</i>=10) and <i>Corynebacterium</i> sp. (<i>n</i>=7), with polymicrobial infections in 19 cases. LVAD could be retained in all patients, with the use of prolonged antibacterial treatment in 34 (94%), and debridement in 17 (47%). One patient died due to LVAD-associated infection.</p><h3>Conclusions</h3><p>LVAD-related infections are common after LVAD implantation, and may be controlled by prolonged antibiotic treatment.</p>

Publisher: Elsevier PMID: 28323195