**8. Conclusions**

Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression although HIV positive LVAD recipients have not had increased rates of infection in the limited number of recipients to date. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection (fever, local induration, erythema, abdominal pain, high flow LAVD parameters, leukocytosis, elevated inflammatory markers such as ESR, CRP; markers of coagulopathy). Elevated BNP may herald severe infection such as sepsis and pump pocket infection. PCR and FISH microbiologic techniques increase diagnostic yield of specific pathogens in biofilm on drivelines and other device components. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include *Staphylococcus*, *Corynebacterium*, *Enterococcus*, *Pseudomonas* and *Candida* spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or *Mycobacterium chimaera* are involved, LVAD removal/re-implantation vs. transplant is necessary, combined with extended antimicrobial therapy. The "holy grail" of future mechanical circulatory support is a fully implantable device that relies on transcutaneous energy supplies. Devices of the future would be less prone to infectious complications potentially but would not entirely eliminate infectious complications. Smaller devices with magnetically levitated pumps, minimally invasive techniques and uniform infection control practices are the state-of the art in preventing infectious complications of LVADs today.
