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Implantation of the Syncardia Total Artificial Heart
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Stroke and the total artificial heart: neurologic considerations

R G Hart1, D G Sherman

  • 1Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio, Texas 78284, USA.

Texas Heart Institute Journal
|March 1, 1987
PubMed

Insights

Total artificial heart (TAH) patients frequently experience strokes from blood clots. Managing anticoagulation after a stroke requires careful consideration of bleeding risks versus recurrent embolism, especially with potential infective endocarditis.

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.

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