Stroke while on long-term left ventricular assist device support: incidence, outcome, and predictors

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Left ventricular assist device (LVAD) support is crucial for managing chronic heart failure.
• Stroke development during LVAD support poses a significant threat to patient morbidity and mortality.

Purpose of the Study:

• To determine the prevalence, types, and predictors of stroke in patients receiving HeartMate II LVAD support.
• To analyze the impact of stroke on morbidity and mortality in this patient population.

Main Methods:

• Retrospective review of 100 patients implanted with HeartMate II LVAD from March 2006 to November 2011.
• Cox multivariate logistic regression analysis to identify independent predictors of postoperative stroke.
• Analysis of stroke types (embolic vs. hemorrhagic), locations, and associated patient factors.

Main Results:

• 12.0% of patients experienced stroke, with 4 embolic and 8 hemorrhagic.
• Independent predictors identified: diabetes, aortic cross-clamping during implant, duration of LVAD support, and international normalized ratio (INR).
• Higher incidence of diabetes and pre-implant stroke history in stroke patients; sub- or supratherapeutic INR noted at stroke onset.

Conclusions:

• Stroke is a critical complication for HeartMate II LVAD patients, contributing to significant morbidity and mortality.
• Strict control of anticoagulation (INR) and risk stratification are essential for minimizing stroke occurrence.
• Further research into stroke predictors and management strategies is warranted for long-term LVAD therapy.