Left ventricular assist device infections: three case reports and a review of the literature.

Left ventricular assist device (LVAD) infections are a major device complication and are associated with significant morbidity. We report three cases of LVAD infections in our institution and review the literature to assess clinical parameters associated with infection, causative organisms, treatment modalities, and patient outcomes. A total of 46 cases were reviewed. Fever, leukocytosis, and drainage from the exit site were the most commonly reported symptoms. Left ventricular assist devices were in place an average of 65 days before the onset of infection. The most common site of LVAD infection was the drive line. Staphylococcus aureus was the most common organism, followed by gram negative rods, Candida, and enterococcus species and coagulase negative Staphylococcus. Treatment consisted primarily of surgical intervention, including incisional debridement, pump pocket exploration, and LVAD replacement and adjunctive intravenous antibiotics, especially vancomycin. Only eight infected patients died before transplantation, with five deaths due to sepsis. Four of these five patients were infected with a gram negative rod. In general, patients who developed an LVAD infection were able to undergo successful transplantation without recurrence, but infection with a gram negative rod was associated with a poor outcome.