Left Ventricular Assist Device Infection - Does Device Exchange Solve the Problem?

Objective: Infection is the most common complication of left ventricular assist device (LVAD) therapy and the exchange of the infected LVAD is currently the most applied therapeutic treatment for this disease. With this study we examine the effects of LVAD exchange on the rate of re-infections and outcome of patients after the exchange.

Methods: Between February 2004 and December 2015 more than 600 LVADs were implanted at our institution. Out of those, we retrospectively studied a patient cohort of 87 patients. The study group (n = 24 patients) underwent LVAD exchange due to device related infection. The control group (n = 63 patients) underwent LVAD exchange due to other reasons such as pump thrombosis or device malfunction. Rates of re-infection were analyzed and compared between the two groups.

Results: Between February 2004 and December 2015 87 exchanges of left ventricular assist devices were performed at Hannover Medical School. Out of those, 24 LVAD exchanges were performed due to device infection. In 63 cases other diagnoses led to LVAD exchange (59 Pump thromboses, 4 technical malfunctions). 21 patients underwent a second LVAD exchange and 3 patients underwent a third exchange procedure. After the first LVAD exchange no patient of the study group showed a re-infection of the LVAD. Three patients of the study group suffered from a pump thrombosis or other device malfunction which led to a second exchange procedure. The majority of infections were caused by Staphylococcus, followed by Pseudomonas and Corynebacteria. Seven patients (38%) of the study group presented positive swaps of the driveline after LVAD exchange. Out of 45 patients of the control group, 5 patients (11%) presented an LVAD infection and 13 (29%) patients with another kind of VAD dysfunction which led to a consecutive LVAD exchange. Out of these 13 patients, one patient was diagnosed with severe device infection which resulted in a third LVAD exchange. Seven patients of the control group (11%) and seven patients of the study group (29%) showed positive swaps of the previous infectious sites after surgery.

Conclusion: It is possible to successfully treat left ventricular assist device infections via LVAD exchange. Yet, the exchange procedure is not without risk and the chance of re-infection remains. Out study suggests that approximately one third of the infectious cases will suffer a re-infection. Therefore, primary prevention of LVAD infection is of upmost importance.

No conflict of interest has been declared by the author(s).