Mechanical Circulatory Support Prior to Heart Transplantation Predicts Early Post-Operative Stroke

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Devices

Background:

• Mechanical circulatory support (MCS) devices are critical for managing advanced heart failure and cardiogenic shock.
• Stroke is a recognized complication associated with MCS therapy.

Purpose of the Study:

• To evaluate the incidence and risk of stroke in the early post-heart transplantation (HT) period for patients who received MCS.
• To identify specific MCS modalities associated with increased stroke risk in the early post-HT phase.

Main Methods:

• Utilized data from the United Network for Organ Sharing (UNOS) database.
• Analyzed patients who underwent HT after receiving MCS, including LVAD, RVAD, BiVAD, and ECMO.
• Employed multiple logistic regression to determine stroke risk associated with different MCS types.

Main Results:

• Out of 10,258 patients receiving MCS leading to HT, 1.96% (160 patients) experienced early post-HT stroke.
• Right ventricular assist devices (RVAD), biventricular ventricular assist devices (BiVAD), and extracorporeal membrane oxygenation (ECMO) were significantly associated with increased stroke risk.
• Odds ratios for stroke were: RVAD (2.89), BiVAD (3.24), ECMO (2.27), and any MCS (1.60).

Conclusions:

• MCS use, excluding LVAD, is independently linked to a higher risk of stroke in the early post-HT period.
• This highlights the need for vigilant stroke prevention strategies in HT recipients supported by certain MCS devices.