Left ventricular assist device driveline infections: recent advances and future goals

Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, but infection remains a substantial risk. LVAD driveline infections (DLIs) are the most common type of LVAD-associated infection (LVADI). In the past several years we have expanded our understanding of DLI epidemiology, standardized the definition of LVADIs, improved infection rates through changes in implantation techniques, and investigated potential new modalities for DLI diagnosis. However, significant challenges remain for optimizing DLI prevention and treatment. These challenges include standardizing and improving both empiric and targeted antimicrobial therapy, expanding our understanding of effective driveline exit site dressings and topical therapies, and defining the patient population that benefits from device exchange and transplant. Additionally, in an era of expanding antibiotic resistance we need to continue investigating novel, non-antibiotic therapies for prevention and treatment of DLIs.