Contemporary Management Strategies in VAD Infection

AbstractPurpose of ReviewThe use of durable ventricular assist devices (VAD) to manage end-stage heart failure is increasing, but infection remains a leading cause of morbidity and mortality among patients with VAD. In this review, we synthesize recent data pertaining to the epidemiology, diagnosis, management, and prevention of VAD infections, discuss transplant considerations in patients with VAD infections, and highlight remaining knowledge gaps. We also present a conceptual framework for treating clinicians to approach these infections that draws on the same principles that guide the treatment of analogous infections that occur in patients without VAD.Recent FindingsDespite advances in device design, surgical techniques, and preventative interventions, more than a third of VAD recipients still experience infection as an adverse outcome. Positron emission tomography has emerged as a promising modality for identifying and characterizing VAD infections. High-quality data to support many of the routine therapeutic strategies currently used for VAD infections —including suppressive antibiotic therapy, surgical debridement/device exchange, and novel antimicrobials for emerging multidrug-resistant organisms—remain limited. Although pre-transplant VAD infection may impact some early transplant outcomes, transplantation remains a viable option for patien ts with most types of VAD infection.SummaryStandardized definitions of VAD infection applied to large registry datasets have...

Source: Current Heart Failure Reports - May 19, 2020 Category: Cardiology Source Type: research