Top Things to Know: Infections of Selected Nonvalvular Cardiovascular Devices
Updated: April 16, 2026
Prepared by Barbara Entl, MD Science and Medicine Advisor American Heart Association
- Infections of prosthetic valves, vascular grafts, cardiovascular implantable electronic devices (CIEDs), and mechanical circulatory support devices are well recognized; infections involving other cardiovascular (CV) devices, however, have received far less attention.
- Nonvalvular CV device infections – including intracardiac devices (e.g., septal closure devices, shunts), intravascular devices (e.g., stents, filters, patches, and monitoring devices), and arteriovenous conduits (e.g., grafts) – are rare but pose substantial clinical challenges due to their life-threatening potential and diagnostic complexity.
- This Science Advisory builds on the 2003 American Heart Association Scientific Statement, “Non-valvular Cardiovascular Device–Related Infections,” highlighting advances in prevention, evaluation, diagnosis, and management, summarizing available evidence, and providing expert guidance on knowledge gaps.
- Nonvalvular CV device infection should be considered in the differential diagnosis of confirmed bloodstream infection (after excluding contamination) when no alternative source is identified, particularly in patients with indwelling CV or intravascular devices, persistent bacteremia despite appropriate therapy, or recurrent infection with the same pathogen.
- Infections of intracardiac devices (e.g., septal closure and left atrial appendage occlusion devices) typically occur within 6 months of implantation but may present later with nonspecific symptoms and features of infective endocarditis. Management generally parallels infective endocarditis, with device explantation considered for persistent infection or complications.
- Ventriculoatrial shunts, used for cerebrospinal fluid diversion when the peritoneal cavity is unsuitable, have an infection risk of ~5%, usually within 6 months of placement. Management includes shunt removal, temporary external ventricular drainage, and pathogen-directed intravenous antimicrobial therapy, typically for ≥10–14 days.
- Peripheral vascular stent infections differ from aortic graft infections in complexity and management. Presentation is often nonspecific, and pseudoaneurysm or distal septic embolization may occur. CTA and MRI can detect structural changes and inflammation but may be limited by metal artifacts. [^18F]FDG PET/CT has emerged as a key modality, particularly when abscess or gas is absent.
- Arteriovenous conduit infections (e.g., hemodialysis grafts) occur in 3–35% of patients and may lead to metastatic complications (e.g., septic emboli). Diagnosis can be aided by ultrasound or leukocyte scintigraphy, which helps distinguish infection from seroma or hematoma. Management ranges from systemic antimicrobials with partial graft resection for localized infection to complete graft removal for extensive involvement.
- Vascular coils and plugs, used to occlude vessels for aneurysms, arteriovenous malformations/fistulas, and hemorrhage control, can become infected weeks to months after implantation. Diagnosis relies on high clinical suspicion, blood cultures, and imaging (ultrasound, CTA, [^18F]FDG PET/CT, or leukocyte scintigraphy) to detect migration, abscess, erosion, pseudoaneurysm, or hypermetabolic activity.
- Infections involving nonvalvular CV devices are uncommon but carry substantial clinical risk, emphasizing the need for heightened awareness, timely recognition, and coordinated multidisciplinary management. Comprehensive evaluation integrating microbiologic data, advanced imaging, and clinical judgment is essential, and care by a multidisciplinary Endocarditis Team is strongly encouraged.
Citation
Chesdachai S, Ghobrial J, El-Chami MF, Dionne A, Lok CE, Gonzalez AA, Heitchmidt MG, Boskovski M, Brida M, Baddour LM; on behalf of the American Heart Association Committee on Rheumatic Fever, Endocarditis and Kawasaki Diseases of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; and the Council on Cardiovascular Surgery and Anesthesia. Infections of selected nonvalvular cardiovascular devices: a science advisory from the American Heart Association. J Am Heart Assoc. Published online April 16, 2026. doi: 10.1161/JAHA.126.050147