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Stroke After Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era
Laura Harvey1, Christopher Holley1, Samit S Roy2
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
The Annals of Thoracic Surgery
|June 14, 2015
Summary
Stroke after continuous-flow (CF-) left ventricular assist device (LVAD) implantation significantly increases mortality risk. Further research into risk factors, anticoagulation, and infections is crucial for reducing stroke incidence in LVAD patients.
Area of Science:
- Cardiology
- Medical Devices
- Neurology
Background:
- Left ventricular assist devices (LVADs) are increasingly vital for managing advanced heart failure.
- Continuous-flow (CF-) LVADs represent a significant advancement in mechanical circulatory support.
Purpose of the Study:
- To investigate the incidence and impact of stroke on clinical outcomes in patients receiving CF-LVADs.
- To identify potential risk factors associated with stroke in this patient population.
Main Methods:
- A single-center retrospective analysis of 230 patients implanted with the HeartMate II CF-LVAD from 2006 to 2013.
- Statistical methods were employed to evaluate stroke incidence, stroke-free rates, and survival outcomes.
Main Results:
- Stroke occurred in 17% of patients (39/230), with 48.7% embolic and 51.3% hemorrhagic.
- The 2-year stroke-free rate was 86.1%. Stroke patients had lower rates of coronary artery disease and prior cardiac surgery.
- Mortality risk was 2.01 times higher in stroke patients compared to stroke-free patients (p=0.004).
Conclusions:
- Stroke in patients supported by CF-LVADs is linked to significantly increased mortality.
- Elucidating stroke risk factors, optimizing anticoagulation, and understanding LVAD-related infections are critical for stroke prevention.
