FDG-PET for the detection of infection in left ventricle assist device: Is there light at the end of the tunnel?

Excerpt

Over the past decade, the use of continuous-flow left ventricular assist devices (LVAD) has increased at a rapid pace. In the United States, approximately 2400 LVAD are implanted annually1 and more than 16,000 patients have already received a continuous-flow LVAD.2 These devices are a life-saving option for advanced heart failure patients who are either not eligible for a heart transplant or too ill to safely wait for a transplant on medical therapy alone. LVAD constitute the following components: (1) an inflow cannula surgically implanted into the left ventricular apex that extracts the blood from the left ventricle (LV) into the pump; (2) a pump enclosure with an impeller that circulates blood; (3) an outflow graft that pulses back the blood from the pump into the ascending aorta; and (4) a surgically tunneled driveline that connects the pump to an external controller that operates and monitors the pump function. The external controller is connected by two power cables to a battery powered source or a power module. Survival rates of patients are continuously improving after implantation of LVAD, but the number of adverse events remains quite high. Approximately 80% of patients will have experienced a major adverse event in the first 2 years after LVAD implantation. The most frequent complications of LVAD are bleeding, infection, and arrhythmia.3 LVAD infection starts usually at the entry point of the percutaneous driveline and extends from there progressively to the LVAD pump. In case of driveline infection, a new driveline can be implanted in another site and connected to the pump. In case of pump infection, replacing the LVAD pump is challenging because of the development of tight adhesions between the system and the heart. The only remaining option is to try to control the progression of pump infection with long-term systemic antibiotherapy and consider urgent cardiac transplant in eligible patients. The precise evaluation of the extent of infection in the LVAD system is, therefore, key to guide the clinical management of these patients. …