Complications of Left Ventricular Assist Devices: A Case Study of Recurrent Bacteremia and Implications for Infection Management

Heart failure (HF) is a complex clinical condition with symptoms that result from ineffective ejection of blood due to functional or structural impairment of the heart. The most common causes of HF include ischemic heart disease, myocardial infarction (MI), hypertension, and valvular heart disease (VHD). As HF progresses to advanced stages, interventions, like left ventricular assist devices (LVADs), become essential, especially for patients ineligible for heart transplantation. However, LVADs carry substantial infection risks, particularly for bacteremia, which complicates management, patient morbidity, and patient outcomes in some cases. Our case involves a 61-year-old male with a medical history of American College of Cardiology (ACC)/American Heart Association (AHA) stage D heart failure secondary to non-ischemic cardiomyopathy, a history of biventricular implantable cardioverter defibrillator (ICD) implantation, and an LVAD as destination therapy who experienced recurrent episodes of LVAD-associated infection. Post-implantation, he developed repeated driveline infections with Methicillin-resistant Staphylococcus aureus (MRSA) and Corynebacterium, necessitating prolonged antibiotic courses, incision and drainage, and wound care, but no device functionality issues. The patient's non-adherence to infection control measures further complicated his clinical course, with multiple hospital admissions due to recurrent infections and associated symptoms. Psychosocial factors, including anxiety and depression, significantly impacted his adherence to driveline care, highlighting the critical role of comprehensive patient support in managing LVAD complications. This case underscores the importance of candidate selection, patient education, and stringent infection control protocols in LVAD management. Early identification of patients at high infection risk, combined with ongoing psychosocial support, can improve outcomes and reduce complications. Given the potential for recurrent infections, enhanced screening for psychosocial issues and preventive strategies are essential for patients undergoing LVAD implantation.