Implantable ventricular-assist devices (VADs) have been approved for use both as a bridge to heart transplantation and as a destination therapy. Rising numbers of patients are surviving with these devices for several years. However, infections of these foreign bodies are serious and frequent complications, often requiring removal of the implant, with serious health consequences. Given the increased use of VADs as life-preserving destination therapy, explantation of these devices in the face of infection is impractical. We evaluated and successfully treated 2 patients with VAD pocket infections referred by the cardiac surgery service at our institution using aggressive surgical and pharmacologic therapy, with the goal of preserving the VADs. However, this is still a largely unsolved dilemma requiring further exploration into prevention and treatment since these devastating infections will likely become a more frequent reconstructive challenge.