Left ventricular assist device infections: From epidemiology to treatment

Infections are among the most frequent and severe complications in patients supported with left ventricular assist devices (LVADs), significantly affecting morbidity, mortality, and transplant candidacy. Driveline infections are the most common, but involvement of the pump or pocket is associated with more complex management and worse outcomes.

We conducted a comprehensive narrative review of current literature on LVAD infections, including epidemiology, updated definitions, microbiology, diagnostic tools, and treatment strategies in both bridge-to-transplant and destination therapy patients.

Infection rates range from 19% to 39%, with Staphylococcus aureus and coagulase-negative staphylococci as the most frequent pathogens. PET/CT improves diagnostic accuracy in cases of suspected deep-seated or ambiguous infection. Antimicrobial therapy is the mainstay of treatment. Suppressive antibiotic therapy may be considered as LVAD cannot be removed easily, though data supporting its use are limited. Surgical strategies, such as debridement, VAC therapy, driveline relocation, and pump exchange, should be adapted to the clinical context. Adjunctive options like bacteriophages and cold atmospheric plasma are under investigation. Prevention through optimized surgical technique and driveline management remains essential.

Management of LVAD infections requires individualized, multidisciplinary strategies. Despite technological advances, prevention and early diagnosis remain critical. Further studies are needed to define best practices and reduce infection-related morbidity.