Infections in mechanical circulatory support

Mechanical circulatory support (MCS) devices represent a major advance in the management of advanced heart failure and cardiogenic shock. Despite significant improvements in device technology and patient outcomes, infection remains the most common adverse event, affecting approximately 37% of patients and contributing substantially to morbidity and mortality. This state-of-the-art, multidisciplinary review comprehensively examines infections in patients who require durable or temporary mechanical circulatory support devices with contributions from experts in advanced heart failure, cardiovascular imaging, infectious diseases, cardiothoracic surgery, and pharmacology. We review the underlying pathophysiology of MCS-related infections, examine current preventative, diagnostic and management strategies, outline established best practices, discuss emerging technologies and therapies, and identify existing knowledge gaps and areas for future investigation.