Quantifying the impact from stroke during support with continuous flow ventricular assist devices: An STS INTERMACS...

Area of Science:

• Cardiology
• Medical Devices
• Neurology

Background:

• Adverse events, particularly strokes, are significant barriers to the wider application of continuous flow durable left ventricular assist devices (LVADs) in ambulatory advanced heart failure patients.
• Understanding stroke incidence and impact is crucial for improving patient outcomes.

Purpose of the Study:

• To analyze the incidence, risk factors, and mortality associated with stroke events following continuous flow LVAD implantation.
• To evaluate the impact of stroke severity on long-term survival.

Main Methods:

• Analysis of 10,285 continuous flow LVAD implantations from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support database (June 2014-June 2017) with follow-up through June 2018.
• Multivariable hazard function analysis and modulated renewal models were used to identify risk factors and mortality predictors.

Main Results:

• 16% of patients experienced at least one stroke, with equal ischemic and hemorrhagic rates. Stroke risk was 4% in the first month, 9% by 6 months, and 14% by 1 year.
• Early risk factors included centrifugal flow devices and concomitant cardiac surgery; long-term risk was associated with non-compliance.
• Ischemic stroke survival at 6 months was 70%, while hemorrhagic stroke survival was <50%. Disabling strokes significantly reduced 1- and 2-year survival.

Conclusions:

• Confirms a 20% stroke incidence within 2 years for axial and hybrid centrifugal flow pumps.
• Disabling strokes markedly increase 1- and 2-year mortality.
• Further research needs comprehensive Modified Rankin Scores and quality of life data to guide prevention and intervention strategies.