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Updated: Jul 27, 2025
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Outcomes of heart transplant recipients with prior left ventricular assist device associated stroke
Aaron Shoskes1, Merry Huang1, Catherine Hassett2
1Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue s100a, Cleveland, OH 44195, USA.
Insights
Patients with left ventricular assist device (LVAD) stroke had similar transplant outcomes, though fewer received transplants. LVAD-associated stroke history should not preclude heart transplantation.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Left ventricular assist devices (LVADs) enhance survival in end-stage heart failure.
- LVADs are linked to ischemic stroke and intracranial hemorrhage (ICH).
- The effect of LVAD-related strokes on heart transplant candidacy and outcomes remains unclear.
Purpose of the Study:
- To evaluate the impact of LVAD-associated stroke on heart transplant eligibility.
- To compare post-transplant survival and outcomes in patients with and without LVAD-associated stroke.
Main Methods:
- Retrospective review of adult patients who received LVADs between 2004-2021.
- Identification of patients who experienced ischemic stroke or ICH post-LVAD implantation.
- Comparative survival analysis for heart transplant recipients with and without a history of LVAD-associated stroke.
Main Results:
- Of 917 LVAD patients, 244 underwent transplant, including 25 with prior LVAD-associated stroke.
- One- and two-year post-transplant survival was 100% and 95% for stroke patients vs. 92% and 90% for non-stroke patients (p=0.156; p=0.323).
- Stroke incidence post-transplant was similar between groups (4-5% vs. 5-6%, p>0.7).
Conclusions:
- Patients with LVAD-associated stroke were less likely to receive a heart transplant.
- However, those transplanted had comparable post-transplant survival and outcomes.
- A history of LVAD-associated stroke should not be an absolute contraindication for heart transplantation.
Background:
Left ventricular assist devices (LVADs) improve survival in patients with end-stage heart failure but are associated with ischemic stroke and intracranial hemorrhage (ICH). The impact of LVAD-associated stroke on transplant candidacy and outcomes has not been characterized.
Methods:
Adult patients undergoing LVAD implantation at Cleveland Clinic between 2004 to 2021 were reviewed and patients who developed ischemic stroke or ICH were identified. Post-transplant survival analysis was performed between patients with LVAD-associated stroke vs. without.
Results:
917 patients had an LVAD implantation of whom 244 (median age 57, 79% male) underwent subsequent transplant including 25 with prior LVAD-associated stroke. The 1- and 2-year survival after transplant in patients with LVAD-associated stroke were 100% and 95% respectively, compared with 92% and 90% in patients without stroke (p=0.156; p=0.323) Similarly, there was no difference in stroke incidence at 1- and 2 years after transplant between patients with LVAD-associated stroke (4% and 5%) and those without prior stroke (5% and 6%, p = 0.884; p=0.744).
Conclusions:
In this single-center retrospective study, patients with LVAD-associated stroke were significantly less likely to undergo heart transplant, but those who underwent heart transplant had similar post-transplant outcomes as patients without history of LVAD-associated stroke. Given the similar outcomes seen in this population, history of LVAD-associated stroke should not be viewed as an absolute contraindication to subsequent heart transplant.
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