Working Formulation for the Standardization of Definitions of Infections in Patients using Ventricular Assist Devices

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Published 1 April 2011

Margaret M. Hannan, MD; Shahid Husain, MD; Frauke Mattner, MD; Lara Danziger-Isakov, MD; Richard J. Drew, MB; G. Ralph Corey, MD; Stephan Schueler, MD, PhD; William L. Holman, MD; Leo P. Lawler, MD; Steve M. Gordon, MD; Niall G. Mahon, MD; John M. Herre, MD; Kate Gould, MB; Jose G. Montoya, MD; Robert F. Padera, MD, PhD; Robert L. Kormos, MD; John V. Conte, MD; Martha L. Mooney, MD

J Heart Lung Transplant. 2011 Apr;30(4):375-84

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Owing to the constant shortage of donor organs, new allocation systems, and improved medical therapies for congestive cardiac failure, the overwhelming trend in cardiac transplantation has been toward listing principally the most critically ill patients, that is, those requiring inpatient inotropic therapy for mechanical circulatory support (MCS). The ventricular assist device (VAD) has an expanding role in the management of these patients, both as a bridge to transplantation and as a destination therapy (ie, alternative to transplantation). The VAD is also increasingly deployed as an alternative to transplantation (destination therapy).

One of the major challenges and limits to the successful use of VADs is infection. VAD-specific and VAD-related infections are difficult to treat and remain a major cause of death in these patients. Currently, there are no standard international definitions for VAD infections. Various infection rates have been published from different centers during the last decade, but practice variation in device, implant technique, and infection diagnosis have limited meaningful comparisons to improve care. The high prevalence of infection-related adverse events in recent studies was similar to previous reports confirming the continued major role of infection to the survival and quality of life for device recipients

The purpose of this document is to provide consensus-derived, standard international definitions that include not only major infection but also comprehensive details of all aspects of VAD-specific and VAD-related infection in these patients. Clinical, microbiologic, histopathological, and radiologic criteria are included in these definitions. The aim of these standard definitions is to improve clinical-investigator communication, allowing meaningful comparison in practice and outcomes between different centers and different VAD devices. 

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