Presenter: Oriol, Manuel, Lausanne, Switzerland
Authors: Oriol Manuel
Ventricular assist devices (VAD) are an established option for patients suffering from end-stage heart failure waiting for heart transplantation or as a destination therapy. While patient survival after VAD implantation may reach up to >80% at one year, a major complication associated with VAD support is the high incidence of infections of the devices, ranging from 25-70%. VAD infections can be life-threatening and/or may jeopardize subsequent transplantation. Any part of the device can be involved in these infections, including the driveline, the pocket or the pump itself. Although Gram positive cocci are the most common pathogens involved in VAD infections, other pathogens such as Pseudomonas aeruginosa, Enterobacteriaciae and Candida have also been described as a cause of VAD infection. Prevention of infection after VAD implantation is challenging, and includes perioperative antibiotic prophylaxis and a strict care of the driveline exit.
The presence of VAD at the time of transplant has not been associated with the development of post-transplant infections and on an overall increasing mortality. However, patients with a pre-transplant VAD infection may have increased early post-transplant mortality. Despite that, heart transplantation is not contraindicated in patients with VAD infection as it may be curative because of the removal of the device during transplantation.
As infection is one of the more worrisome complications after VAD implantation, it is essential to develop new strategies and prospective studies to optimize prevention and treatment of VAD infections.
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