Cerebrovascular Events After Continuous-Flow Left Ventricular Assist Devices
Cerebrovascular events (CVE) are among the most common and serious complications after implantation of continuous-flow left ventricular assist devices (CF-LVAD). We studied the incidence, subtypes, anatomical distribution, and pre- and post-implantation risk factors of CVEs as well as the effect of CVEs on outcomes after CF-LVAD implantation at our institution.
Retrospective analysis of clinical and neuroimaging data of 372 patients with CF-LVAD between May 2005 and December 2013 using standard statistical methods.
CVEs occurred in 71 patients (19%), consisting of 35 ischemic (49%), 26 hemorrhagic (37%), and 10 ischemic+hemorrhagic (14%) events. History of coronary artery disease and female gender was associated with higher odds of ischemic CVE (OR 2.84 and 2.5, respectively), and diabetes mellitus was associated with higher odds of hemorrhagic CVE (OR 3.12). While we found a higher rate of ischemic CVEs in patients not taking any antithrombotic medications, no difference was found between patients with ischemic and hemorrhagic CVEs. Occurrence of CVEs was associated with increased mortality (HR 1.62). Heart transplantation was associated with improved survival (HR 0.02). In patients without heart transplantation, occurrence of CVE was associated with decreased survival.
LVADs are associated with high rates of CVE, increased mortality, and lower rates of heart transplantation. Further investigations to identify the optimal primary and secondary stroke prevention measures in post-LVAD patients are warranted.
KeywordsStroke Left ventricular assist device Heart failure Cardiac transplant
PT-F, DRC, AAD, and ARZ involved in study concept and design. PT-F, DRC, AAD, LR-L, NY-F-A, and ARZ helped in acquisition, analysis, or interpretation of data. LR-L helped in statistical analysis. PT-F drafted the manuscript. MEN, SJL, Ewald, ARZ contributed to critical revision of the manuscript for important intellectual content. ARZ helped in study supervision.
This study was supported, in part, by research funds from the National Institutes of Health (NIH Grant U10 HL110309, Heart Failure Network) and Grant Number UL1 TR000448 R01 HL097036.
Compliance with Ethical Standards
GAE has received research support from Biocontrol, CareDx, and Medtronic and consulting fees from Abbott. The other authors have no conflict to report.
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