Infection and Sepsis
Infection is a major cause for morbidity and mortality in LVAD
patients. Although the prevalence of VAD associated infections is improving with second and third generation devices, it continues to be a worrisome complication, with 20 % of VAD deaths attributed to infection.60,61
According to the International Society of Heart and Lung Transplantation (ISHLT) data, 87 % of VAD infections are bacterial (primarily Staphylococcus and Pseudomonas species) with the reminder being mostly fungal.62,63 The clinical presentation of VAD infections may be nonspecific and misleading, with symptoms such as lethargy, fatigue, or anorexia, with or without fever or shock.64 Table 7 summarises the ISHLT Infectious Diseases Working Group definition of infection in VAD patients.
Driveline infections are the most prevalent infections in VAD patients and may reflect the presence of a deeper infection of the device hardware (pump, cannula) or the pocket space. Due to the marked variability in the clinical presentation, vigilance is required for an early diagnosis of infection.
The Future of Ventricular Assist Device Therapy
The surge in the prevalence of HF worldwide will result in a substantial rise in the number of patients treated with long-term MCS. The next generation devices are currently being evaluated in clinical trials. These devices are smaller and easier to implant. Moreover, they are designed to have more flexible percutaneous leads, in an effort to decrease the risk of infections.65,66 Future devices will be more physiologic and will be able to automatically accommodate
to the patient’s physical activity and position. In addition, devices in the future will have trans-dermal charging so that the system is totally within the body, which will further decrease the risk of infection, and allow patients to swim and shower with no limitation on daily activities.