The left ventricular assist device (LVAD) has revolutionized the care
of patients with heart failure who are awaiting transplantation. Despi
te reports of significant infection rates associated with LVAD implant
ation, few data are available concerning the management of LVAD-relate
d infections and their impact on transplantation. Eight (40%) of our f
irst 20 LVAD recipients developed infections. LVAD-related bloodstream
infection occurred in three (15%) patients; infection was due to Stap
hylococcus aureus in one case, coagulase-negative staphylococci in the
second case, and S. aureus and Candida tropicalis in the third case.
All three patients were treated with courses of antibiotics that were
appropriate for prosthetic valve endocarditis and received antibiotics
for at least 6 weeks. All infected patients underwent successful tran
splantation and had no evidence of recurrence of infection up to 16 mo
nths postoperatively. Our experience suggests that LVAD infections can
be successfully treated without device removal and that cardiac trans
plantation can be performed in individuals with LVAD-related bloodstre
am infection.