Infectious complications in left ventricular assist device recipients

The left ventricular assist device (LVAD) has revolutionized the care of patients with heart failure who are awaiting transplantation. Despite reports of significant infection rates associated with LVAD implantation, few data are available concerning the management of LVAD-related infections and their impact on transplantation. Eight (40%) of our first 20 LVAD recipients developed infections. LVAD-related bloodstream infection occurred in three (15%) patients; infection was due to Staphylococcus aureus in one case, coagulase-negative staphylococci in the second case, and S. aureus and Candida tropicalis in the third case. All three patients were treated with courses of antibiotics that were appropriate for prosthetic valve endocarditis and received antibiotics for at least 6 weeks. All infected patients underwent successful transplantation and had no evidence of recurrence of infection up to 16 months postoperatively. Our experience suggests that LVAD infections can be successfully treated without device removal and that cardiac transplantation can be performed in individuals with LVAD-related bloodstream infection.