Managing device infections: are we progressing or is infection an insurmountable obstacle?

This article reviews infections that occur in patients with implanted mechanical circulatory support devices and presents recent data for signs of progress in controlling the incidence and impact of these infections. Two types of comparisons are used to examine this question. First, the outcomes of patients with HeartMate vented electric left ventricular assist devices (VADs) (Thoratec Corp, Pleasanton, CA) implanted during the REMATCH Trial are compared with the outcome of more recent patients who received this pump as destination therapy. Second, the outcome of patients who received a smaller left VAD (e.g., an axial flow VAD) or a fully implanted left VAD are reported and contrasted with results from the REMATCH era. Data are presented to support the hypothesis that improvements in patient selection, patient management, device durability, and device design have resulted in lower rates of infection and infection-related death for patients who require mechanical circulatory support.