Ventricular Assist Device Infections: Epidemiology, Treatment, and Outcomes in Transplant

To review the current literature on ventricular assist device (VAD) infections, with emphasis on epidemiology, treatment, and post-transplant outcomes.

Clarification on VAD infections is an ongoing process, with the INTERMACS 2020 report differentiating between mechanical circulatory support (MCS) related infections and MCS unrelated infections, with patient-related factors as further categorization. New data indicates colonization with multidrug resistant organisms (MDR) correlates with development of VAD-associated infections. Exploration of bacteriophages use for treatment of VAD related infections is still ongoing. Additionally, patients with VAD related infections who undergo transplant have similar outcomes to VAD patients without infection.

In the evolving landscape of MCS, VADs remain a cornerstone of management for those with advanced heart failure who may not qualify for transplant. VAD related infections are a common complication, with efforts to understand and mitigate risk ongoing. Once infected, management is dependent on the component of the VAD involved – with topical and local efforts the focus of recent research for drive line exit site infections. If transplant is an option for a patient with a VAD related infection, their outcomes are similar to other patients with VADs.