Clinical characteristics and outcomes of left ventricular assist device (LVAD) infections: Could driveline infections be a predictor of deep-seated infections?

The global shortage of donor hearts has led to a growing population of patients supported with left ventricular assist devices (LVADs). Although LVAD implantation improves survival in advanced heart failure, infectious complications continue to contribute substantially to morbidity during long-term follow-up. Typically beginning as superficial driveline infections, these may progress to deep-seated and difficult-to-treat infections, often resulting in chronic disease. This study aimed to characterize mechanical circulatory support specific infections (MCS-s), evaluate their clinical impact particularly on mortality, and explore predictors of deep-seated infection. We conducted a retrospective cohort study including adult patients who underwent LVAD implantation between 2019 and 2025. Clinical, microbiological, and outcome data were collected from medical records, and descriptive statistics were performed. Infections were classified according to the 2024 ISHLT criteria. The primary objective was to explore predictors of deep-seated infections among patients with MCS-s infections. Fifty patients were included with a follow-up of median (IQR) 392.5 days (33.5–1335). A total of 72 infection episodes were recorded, of which 57 were MCS-s infections occurring in 21 patients (42%). Driveline infections were the most common presentation ( n = 17, 34%). Staphylococcus aureus was the predominant pathogen and was strongly associated with deep-seated infection (90% vs. 42%, p = 0.019). Fever was also prominent symptom observed more commonly in patients with deep-seated infections ( p = 0.016). Persistent driveline drainage also emerged as a significant predictor and was associated with increased risk of readmission following antibiotic therapy. The Kaplan–Meier estimated 1-year survival after LVAD implantation was 66.3%. While MCS-s infections were frequent and clinically burdensome, they were not independently associated with mortality in this cohort. Our findings suggest that persistent drainage despite antimicrobial therapy, the presence of fever, and S. aureus isolation may identify a subgroup of patients at increased risk for progression from uncomplicated driveline infection to deep-seated infection. In such patients, early utilization of imaging modalities may facilitate timely diagnosis, improve source control strategies, and potentially prevent further infectious complications.