CARDIOVASCULAR
ENGINEERING
Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
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CARDIOVASCULAR
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Volume 2, 1997, No 1 |
Abstract:
Background: Left ventricular assist devices (LVADs) have emerged
as a viable option in the management of end-stage heart disease.
Diagnosis of "LVAD endocarditis", or infection of the
left ventricular device surface associated with clinical
manifestations of sepsis, can be difficult, since distinction
from other sources of infection is often not possible. Methods:
At our institution, 61 TCI Heartmate LVADs were implanted in 59
patients over 5 years, with an average support time of 101 days.
Detailed medical records were kept prospectively for all
patients, and for the purposes of the present study, a variety of
infection-related endpoints were analysed. Results: Twenty-nine
patients (48%) developed clinical evidence of infection
(fever/leukocytosis) during LVAD support and 11 patients (17%)
had positive LVAD cultures upon explantation. Of the patients
with positive explant cultures, 8 had clinical manifestations of
infection (LVAD endocarditis), while in three, the positive
cultures were not associated with clinical sequelae.
Manifestations of LVAD endocarditis included persistent fever
with positive blood cultures, septic cerebral embolization,
progressive cachexia, LVAD inflow valve obstruction, and LVAD
outflow graft rupture. Infections were managed successfully in
four patients (50%) by LVAD replacement, transplantation, LVAD
explantation without transplantation and antibiotic suppression.
The remaining four patients died from septic cerebral emboli (1),
outflow graft rupture (1) and multiple organ failure (2).
Conclusions: LVAD endocarditis is an entity characterized by LVAD
surface or graft colonization and bacteremia or fungemia and is
confirmed by explanted device culture. Clinical manifestations
may resemble those of classical endocarditis (persistent fever
and cachexia), but also include mechanical complications such as
device obstruction, graft erosion and systemic embolization.
Although antibiotic suppression therapy was effective in one
patient, three others required emergent device removal or
replacement, demonstrating that early operative intervention will
be warranted and can be successful for a subset of patients.
Keywords:
mechanical cardiac assistance, LVAD, infection, endocarditis
Address for Correspondence:
Reference:
(CVE. 1997; 2 (1): 11-15)
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