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Implantation of Left Ventricular Assist Device (LVAD) in Juvenile Landrace Swine: A LVAD Implantation Model of Pediatric Heart Failure
Published on: January 16, 2026
Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices
Jennifer A Frontera1, Randall Starling2, Sung-Min Cho1
1Department of Neurology, New York University, New York, New York.
Insights
Stroke is a significant cause of death in patients with left ventricular assist devices (LVADs). Managing modifiable risk factors like hypertension and pump issues may reduce stroke and mortality risks.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Stroke is a primary cause of mortality following left ventricular assist device (LVAD) implantation.
- Understanding stroke incidence and predictors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, timing, and predictors of ischemic and hemorrhagic strokes in patients with LVADs.
- To assess the association between stroke subtypes and mortality in this patient population.
Main Methods:
- A prospective review of data from 402 patients with HeartMate II and HeartWare LVADs was conducted.
- Analysis focused on early (in-hospital) and late (post-discharge) stroke events, their types, and associated mortality risks.
Main Results:
- 17% of patients experienced 83 strokes; incidence was highest early post-implant and again at 9-12 months.
- Early hemorrhagic stroke, late ischemic stroke, and late hemorrhagic stroke were significant predictors of death.
- Modifiable risk factors including tobacco use, bacteremia, pump thrombosis/infection, and hypertension were associated with stroke.
Conclusions:
- Stroke is a leading cause and predictor of death in LVAD patients, with a bimodal risk pattern.
- Targeting modifiable risk factors is essential for mitigating stroke and mortality rates in LVAD recipients.
Background:
Stroke is a major cause of mortality after left ventricular assist device (LVAD) placement.
Methods:
Prospectively collected data of patients with HeartMate II (n = 332) and HeartWare (n = 70) LVADs from October 21, 2004, to May 19, 2015, were reviewed. Predictors of early (during index hospitalization) and late (post-discharge) ischemic and hemorrhagic stroke and association of stroke subtypes with mortality were assessed.
Results:
Of 402 patients, 83 strokes occurred in 69 patients (17%; 0.14 events per patient-year [EPPY]): early ischemic stroke in 18/402 (4%; 0.03 EPPY), early hemorrhagic stroke in 11/402 (3%; 0.02 EPPY), late ischemic stroke in 25/402 (6%; 0.04 EPPY) and late hemorrhagic stroke in 29/402 (7%; 0.05 EPPY). Risk of stroke and death among patients with stroke was bimodal with highest risks immediately post-implant and increasing again 9-12 months later. Risk of death declined over time in patients without stroke. Modifiable stroke risk factors varied according to timing and stroke type, including tobacco use, bacteremia, pump thrombosis, pump infection, and hypertension (all p < 0.05). In multivariable analysis, early hemorrhagic stroke (adjusted odds ratio [aOR] 4.3, 95% confidence interval [CI] 1.0-17.8, p = 0.04), late ischemic stroke (aOR 3.2, 95% CI 1.1-9.0, p = 0.03), and late hemorrhagic stroke (aOR 3.7, 95% CI 1.5-9.2, p = 0.005) predicted death, whereas early ischemic stroke did not.
Conclusions:
Stroke is a leading cause and predictor of death in patients with LVADs. Risk of stroke and death among patients with stroke is bimodal, with highest risk at time of implant and increasing risk again after 9-12 months. Management of modifiable risk factors may reduce stroke and mortality rates.
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