FDG PET/CT imaging for LVAD associated infections.

HEART FAILURE IS A MAJOR CAUSE OF MORBIDITY AND MORTALITY, particularly among patients with advanced disease and no access to cardiac transplantation. Owing to the constant shortage of donor hearts, the role of left ventricular assist device (LVAD) has been expanding in the management of these patients both as a bridge to transplantation and as a destination therapy (i.e., alternative to transplantation) (1). Although lifesaving, LVAD is often complicated with infections. In the REMATCH (Randomized Evaluation of Mechanical Assistance for the treatment of Congestive Heart Failure Trial), where LVAD was first evaluated as destination therapy, 42% and 52% of patients developed sepsis at 1 year and 2 years after implantation, respectively (2). The percutaneous driveline, that exits the abdomen, can get disrupted by normal every day activities such as showering, which introduces bacteria. Once bacteria infect the driveline and then the bloodstream, eradication of infection is difficult. Bacteria can infect all areas of the LVAD including driveline, pump, cannula, and tissues surrounding the pump. Treatment modalities include long-term antibiotics, LVAD replacement, debridement, and urgent transplant. LVAD infection portends poor prognosis, and treatment options are limited. We present a negative (Fig. 1) and a series of LVAD infection cases (Figs. 2 to 5) demonstrating classic imaging manifestations on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/ CT). FDG PET/CT imaging of the LVAD is a potential tool to make an early and accurate diagnosis of LVAD infection. FDG PET/CT imaging may allow earlier detection of LVAD infection and its extent, as well as evaluation of response to therapy.