This session focused on infectious complications in patients with LVADs. The first case involved a patient with a history of recurrent driveline organisms who presented with Pseudomonas aeruginosa bacteremia and urine culture positivity, raising questions about urinary source versus LVAD-associated infection, the role of echocardiography, and the implications of persistent bacteremia in a patient with implanted hardware. A second case centered on a chronic driveline wound with progressive drainage and local complications, illustrating the challenge of distinguishing superficial from deep driveline infection.
The teaching portion reviewed the epidemiology and clinical presentation of LVAD infections, with emphasis on newer definitions distinguishing uncomplicated percutaneous lead infections from complicated infections. Key themes included how to interpret drainage cultures and blood cultures, when to pursue imaging, how to think about source control when hardware cannot easily be removed, and when prolonged therapy or chronic suppression may be needed.