Fungal left ventricular assist device endocarditis

Background. Infection remains as the most serious complication and represen ts a significant threat to patients during long-term mechanical circulatory support. Fungal infection is a particularly worrisome complication and lef t ventricular assist device (LVAD) endocarditis does pose a serious threat. Methods. One hundred and sixty-five patients underwent TCI Heartmate LVAD i mplantation between July 1991 and December 1999 at our institution. Detaile d medical records were kept prospectively for all patients, and a variety o f infection-related endpoints were analyzed on patients with fungal LVAD en docarditis. Results. Thirty-seven patients (22%) developed fungal infections during LVA D support. Five (3%) of those met our criteria for the diagnosis of fungal LVAD endocarditis. Microbial portals of entry were identifiable in all case s. Infections were managed successfully in 4 patients (80%). Conclusions. The successful management of fungal LVAD endocarditis currentl y requires early recognition of potentially nonspecific signs and symptoms, and timely institution of antifungal therapy. In some cases with device-sp ecific manifestations of LVAD endocarditis, device removal and replacement is necessary. In patients with clinical manifestations of sepsis and fungal driveline site or pocket infections without positive blood culture, urgent transplantation may be the appropriate management. In the setting of short age in the donor supply, device removal and replacement is necessary.