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Infectious complications associated with ventricular assist systems.
T J Myers1, T Khan, O H Frazier
1Cullen Cardiovascular Research Laboratories, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston 77225-0345, USA.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 8, 2000
Summary
Infectious complications affect nearly half of ventricular assist system (VAS) recipients, impacting outcomes. New VAS designs and therapies aim to reduce these serious infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomedical Engineering
Background:
- Infectious complications are a significant concern for patients supported by ventricular assist systems (VAS), leading to severe morbidity and mortality.
- The incidence of VAS infections is difficult to ascertain due to a lack of uniform definitions, with reported rates varying significantly based on device type and duration of support.
- Infections are broadly categorized by device involvement and severity, influencing eligibility for heart transplantation.
Purpose of the Study:
- To review the incidence, classification, predisposing factors, and potential improvements in managing infectious complications associated with ventricular assist systems (VAS).
- To highlight the challenges in accurately defining and reporting VAS infections.
- To discuss strategies for mitigating infection risk and improving long-term patient outcomes.
Main Methods:
- Review of existing literature on infectious complications in ventricular assist system (VAS) recipients.
- Analysis of infection rates based on implantable versus external VAS.
- Classification of infections by device involvement and severity.
Main Results:
- Approximately 50% of patients with implantable VAS and 28% with external VAS experience infections.
- Postoperative bleeding and indwelling devices (endotracheal tubes, catheters) are identified as key predisposing factors.
- Milder infections do not necessarily preclude successful heart transplantation, while severe device-related infections can be a contraindication.
Conclusions:
- Improving VAS designs, such as smaller, less thrombogenic devices with better flow, and incorporating transcutaneous energy transmission systems, is crucial for reducing infection rates.
- Novel therapeutic approaches, including antibiotic-impregnated drivelines and antibiotic beads, show promise in infection control.
- Effective management of infectious complications is essential for optimizing outcomes and enabling long-term support with ventricular assist systems.