MANAGEMENT OF LEFT-VENTRICULAR ASSIST DEVICE INFECTION WITH HEART-TRANSPLANTATION

Background. Left ventricular assist devices (LVADs) are being used as bridges to heart transplantation (HT). Infection of the LVAD in this p atient population represents a serious complication, as simple LVAD re moval or delaying HT may result in death. To improve outcomes in this group of patients, we performed HT in the presence of LVAD infection. Methods. Eighteen patients underwent LVAD implantation followed by HT. Ten underwent HT in the absence of LVAD infection (group 1); and 8, i n the presence of LVAD infection (group 2). All patients were treated similarly except for modification of immunosuppression in group 2 pati ents. Results. Infectious and noninfectious complications were equival ent between the two groups. There was no difference between groups in regard to intraoperative deaths (one versus none), long-term survival (8/10 versus 7/8), wound complications (three versus none), and mean l ength of hospital stay after HT (21 versus 26 days). Conclusions. Pati ents with LVAD infection are too seriously ill to allow LVAD removal o r delay of HT. Transplantation in the face of infection is an effectiv e treatment option. (C) 1997 by The Society of Thoracic Surgeons.