Stroke and the total artificial heart: neurologic considerations

Area of Science:

• Cardiovascular Surgery
• Neurology
• Critical Care Medicine

Background:

• Total artificial heart (TAH) implantation is associated with frequent and severe neurologic complications, primarily ischemic stroke.
• Strokes in TAH patients often result from emboli originating from prosthetic surfaces, typically affecting the middle cerebral artery.
• Cardioembolic strokes present abruptly and have a propensity for hemorrhagic transformation.

Purpose of the Study:

• To discuss the complexities of managing acute stroke in patients with total artificial hearts.
• To provide recommendations for anticoagulation strategies in TAH patients experiencing stroke.
• To address the risks of infective endocarditis and its impact on stroke management in TAH recipients.

Main Methods:

• Review of existing literature on neurologic complications following TAH implantation.
• Analysis of stroke mechanisms, including cardioembolism and prosthetic surface thrombogenesis.
• Evaluation of anticoagulation risks and benefits in the context of stroke and potential infective endocarditis.

Main Results:

• Anticoagulation management is critical, balancing the risk of hemorrhagic transformation against recurrent embolism.
• Temporary cessation of anticoagulation (24-48 hours) may be advisable for large cardioembolic infarcts.
• Infective endocarditis presents a complex scenario, potentially necessitating continued anticoagulation despite stroke.

Conclusions:

• Stroke management in TAH patients requires individualized anticoagulation strategies.
• Careful consideration of bleeding risk, stroke etiology, and prosthetic material is essential.
• Recommendations are provided for optimizing acute stroke care in the TAH population.