An LVAD, or Left Ventricular Assist Device is "a surgically implanted mechanical pump designed to take over the function of a severely weakened left ventricle" (Elmi, 2024, para 1). LVADs are used for patients who are in severe heart failure. LVADs make It possible for a weak heart to pump oxygenated blood throughout the body to vital organs. Patients that require an LVAD can be in transition to a heart transplant, or they could need the LVAD for the duration of their life.
One of the many complications and risks that can take place while having an LVAD is infection. Unfortunately, infection is one of the most common complications after getting an LVAD (Aburjania et al., 2021 para 3). There are many infections that can take place with an LVAD. An infection can occur on or near the pump or at the driveline site.
The most common infections in LVADs occur within the first three months post-VAD, with non-VAD infections being the number one cause of infection followed by VAD-specific infections, then driveline infections (Aburjania et al., 2021 para 3).
Types of Infections
Non-VAD infections are those infections that are not specifically related to the VAD but can happen prior to or right after LVAD implantation. These infections may include sepsis, pneumonia, as well as any other hospital acquired infection (Trachtenberg et al., 2015, para 3). Another common cause of infection includes percutaneous site infections (Trachtenberg et al., 2015, para 3). Of the different types of infections, the “Staphylococcus species comprise the most common type of causative organism, followed by Pseudomonas species, which become even more prominent with longer time on VAD support and are very difficult to eradicate” (Trachtenberg et al., 2015, para 4).
Causes of Infection
There are a few causes of these infections. One of the most likely reasons is breaking the skin barrier, especially near the driveline site (Trachtenberg et al., 2015, para 3). According to Trachtenberg et al. (2015), percutaneous site infections are believed to form a biofilm that make it extremely difficult to rid of bacteria (para 4). The bacterium species Pseudomonas and Staphylococcus are also known to produce a biofilm as well; this makes it doubly difficult to eradicate (Trachtenberg et al., 2015, para 5). Another cause of infection is the hospital stay itself. The longer a patient is in the hospital, the more at risk for infection they are. A new VAD patient has a hospital stay length of a few weeks to recover from the procedure and to check off on all of the VAD education that is required. This puts them at an even larger risk for infections.
Treatments
Once a wound or blood culture is sent to the lab to identify the specific type of infectious organism, then a provider can start an antibiotic that is tailored to fight that specific infection (Trachtenberg et al., 2015, para 10). Depending on the severity of the infection, the patient may be on oral or intravenous antibiotics. Some patients may even need to be on oral antibiotics for months following the VAD implantation. The LVAD site may also require wound care which can include dressing changes, surgical debridement, retunneling of the driveline, resection of the area, or the application of a wound vac (Trachtenberg et al., 2015, para 11). Patients that develop infections will be closely followed after discharge.
Conclusion
Infections in LVADs can be detrimental to a patient’s post op recovery. When a patient gets an infection in an LVAD it can lead to problems getting on the transplant recipient list and can cause systemic problems like a bloodstream infection. LVADs can be difficult to replace and may not be an option for patients with recurring infections. Due to the biofilm present in the more common bacteria In VAD infections, it is not easy to get rid of. It is extremely important that providers identify early signs and symptoms of infection in order to treat it early and efficiently. It can be a matter of life or death.
References:
Elmi, N. (2024, May 1). A lifesaving technology: An introduction to lvads. MedReport Foundation. https://www.medreport.foundation/post/a-lifesaving-technology-an-introduction-to-lvads
Aburjania, N., Hay, C., & Sohail, M. (2021). Continuous-flow left ventricular assist device systems infections: current outcomes and management strategies. Annals of Cardiothoracic Surgery 10(2), 233-239. doi:10.21037/acs-2020-cfmcs-26
Trachtenberg, B. H., Cordero-Reyes, A., Elias, B., & Loebe, M. (2015). A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist DeBakey cardiovascular journal, 11(1), 28–32. https://doi.org/10.14797/mdcj-11-1-28 Assessed and Endorsed by the MedReport Medical Review Board