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Updated: Jan 17, 2026
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Stroke in patients with left ventricular assist device (LVAD): who is at risk?-a retrospective observational study at
Yasemin Akalan1, Hans Worthmann2, Dominik Berliner1
1Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Insights
Patients requiring dialysis after left ventricular assist device (LVAD) implantation face increased stroke risk. A history of stroke also predicts future cerebrovascular events (CVE) in LVAD patients.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Stroke is a critical complication for patients with left ventricular assist devices (LVADs).
- LVADs significantly impact patient quality of life and survival rates.
- Understanding stroke risk factors in LVAD patients is crucial for improving outcomes.
Purpose of the Study:
- To investigate the clinical features of stroke in LVAD patients.
- To identify risk factors associated with cerebrovascular events (CVE) in LVAD recipients.
- To explore potential therapeutic targets for stroke prevention and management in this population.
Main Methods:
- A cohort of 249 consecutive patients undergoing LVAD implantation was analyzed.
- Data collected included clinical characteristics, perioperative management, risk factors, comorbidities, and brain imaging.
- Etiology, treatment, and outcomes of stroke events were assessed using competing risks regression analysis.
Main Results:
- Eighty-three cerebrovascular events (CVE) occurred in 54 patients over a median follow-up of 2.2 years.
- Postoperative dialysis was significantly associated with a higher risk of early CVE (HR 3.617).
- A history of stroke was identified as a significant factor for late CVE (HR 3.564).
Conclusions:
- Postoperative dialysis increases the risk of early cerebrovascular events (CVE) in left ventricular assist device (LVAD) patients.
- A prior history of stroke is a key predictor for late CVE in LVAD recipients.
- Heightened awareness and monitoring are necessary for patients with a history of stroke or complicated clinical courses.
Objectives:
Stroke is a severe complication in patients with left ventricular assist devices (LVAD), significantly affecting quality of life and potentially leading to death. This study aimed to illustrate the clinical features, outcomes, and risk factors associated with stroke in LVAD patients, with the goal of identifying potential treatment targets.
Methods:
In a study of 249 consecutive patients who underwent LVAD implantation, detailed evaluations were conducted regarding clinical characteristics, perioperative management, cardiovascular risk factors, comorbidities, and brain imaging. The etiology, treatment, and outcomes were subsequently assessed in individuals who encountered a stroke.
Results:
Eighty-three cerebrovascular events (CVE) occurred in 54/249 patients during a median study period of 2.2 years (0.4-3.5) with 53 ischemic events and 22 intracranial hemorrhages (ICH). Early peri- or postoperatively CVE in context to the LVAD implantation were identified in 31 patients. Competing risks regression analysis revealed that postoperative dialysis was associated with higher risk for CVE, considering death as competing risk event (HR 3.617; 95%-CI: 1.78-7.35; p ≤ 0.001). Modified Rankin Scale at outpatient visit did not differ in early CVE [3 (IQR 2-5) vs. 3 (IQR2-4), p = 0.146]. Late CVE frequently occurred during hospitalization for sepsis or in cardiac rehabilitation [n = 16/41 events (39%)]. Competing risk analysis treating death and heart transplantation as competitors identified history of stroke as associated factor [HR 3.564; 95%-CI (1.67-7.169); p = 0.001]. Mortality was not associated with CVE [with n = 27/54 (50%) vs. without CVE 94/195 (48.2%) p = 0.183].
Conclusion:
Patients who require postoperative dialysis face a heightened risk for early cerebrovascular events (CVE) during and after LVAD implantation. Additionally, a history of stroke and complicated clinical courses should increase awareness regarding the potential for impending CVE in the long term.
