*Purpose: We routinely use gallium-67 single photon emission computed tomography (⁶⁷Ga-SPECT-CT) to determine the presence and extent of left ventricular assist device (LVAD) infections. The advantages of ⁶⁷Ga-SPECT-CT over alternative nuclear studies include cost and availability. We present the largest series of ⁶⁷Ga-SPECT-CT scans on suspected LVAD device related infections (DRIs) to date, and show the effect on patient management.

*Methods: MONTAGE™ was used to identify and review ⁶⁷Ga-SPECT-CT scans on LVAD patients from July 2011 to June 2018. Demographic information collected included age, sex, cardiomyopathy, LVAD type, and presence of diabetes. Standard ISHLT criteria were used to classify LVAD-specific DRIs. The microbiology of blood and wound cultures was reviewed. Charts were reviewed to determine whether ⁶⁷Ga-SPECT-CT results led to changes in antimicrobial therapy, LVAD revision or exchange, or the decision to apply for a 1A exception for heart transplantation listing due to LVAD DRI.

*Results: There were 41 cases, mostly males (80.5%), average age 56.6 years, with HeartMate II devices (82.9%). DRIs were classified as possible (12.2%), probable (36.6%), proven (36.6%) or rejected (14.6%). Most VAD-specific infections were percutaneous deep driveline infections (34.1%) and VAD-related infections were primarily bloodstream infections (31.7%). Staphylococcus aureus was the major pathogen isolated from 20 positive wound swabs (58.6%) and 18 positive blood cultures (50.0%). The ⁶⁷Ga-SPECT-CT resulted in changes in management in over half (53.7%) of all patients: starting (24.4%) or stopping (17.1%) antimicrobial therapy, LVAD revision (22.0%) or exchange (12.2%), and the application for 1A exception for transplant listing (17.1%).

*Conclusions: ⁶⁷Ga-SPECT-CT is an effective modality for determining the presence and extent of LVAD DRIs, and contributed to a change in medical or surgical management in more than half of all cases studied.

« Back to 2019 American Transplant Congress