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Updated: Dec 22, 2025
Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Case report: atypical fungal obstruction of the left ventricular assist device outflow cannula
Jiri Maly, Ondrej Szarszoi, Zora Dorazilova
1Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9 140 21 Prague 4, Prague, Czech Republic. mpok@ikem.cz.
Abstract:
We describe a very rare case of outflow cannula obstruction with fungal infectious thrombus formation. Discussion includes the etiology, diagnosis, and management of fungal infection complications related with long-term mechanical circulatory support. Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure. Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [Ann Thorac Surg 90:1270-1277, 2010]. Device-related infections can be categorized as driveline infections, pump-pocket infections, and LVAD-associated endocarditis [Expert Rev Med Devices 8: 627-634, 2011]. The microbiological profile is very heterogeneous; the most common pathogens are Staphylococcus, Pseudomonas, Streptococcus species, and Candida. Severe fungal infection may lead to dysfunction of the LVAD due to obstructive mass formation within the device. Due to the only anecdotal reports in the current literature, we present a very rare case of outflow fungal infectious thrombus formation leading to outflow cannula obstruction in patient with LVAD.
Insights
This study reports a rare case of fungal infection causing a thrombus that obstructed a left ventricular assist device (LVAD) outflow cannula. It highlights the risks of fungal complications in long-term mechanical circulatory support.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure patients awaiting transplant or long-term support.
- Continuous-flow LVADs improve outcomes but carry risks of infection, a significant long-term complication.
- Device-related infections include driveline, pump-pocket infections, and LVAD endocarditis.
Observation:
- A rare case of fungal infectious thrombus formation obstructing an LVAD outflow cannula is presented.
- The microbiological profile of LVAD infections is diverse, with fungi like Candida being potential pathogens.
- Severe fungal infections can cause LVAD dysfunction through obstructive mass formation.
Findings:
- Fungal infectious thrombus formation can lead to critical outflow cannula obstruction in LVAD patients.
- This complication, though rare, underscores the need for vigilance regarding fungal infections in mechanical circulatory support.
- Management strategies for fungal complications in LVAD patients require careful consideration.
Implications:
- Early diagnosis and management of fungal infections are vital to prevent LVAD dysfunction.
- This case contributes to the limited literature on severe fungal complications associated with long-term LVAD support.
- Further research is needed to understand and mitigate fungal infection risks in LVAD recipients.
