Risk Factors of Stroke After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis

Stroke is a leading cause of death and disability in left ventricular assist device (LVAD) patients. Previous studies have identified some risk factors for post-LVAD stroke, but more systematic, quantitative evidence is needed.

The literature on risk factors related to post-LVAD stroke was searched and sorted using PubMed and Web of Science. Risk quantification employed standardized mean differences (SMDs)/odds ratios (ORs). Subgroup analyses, sensitivity analyses, and publication bias assessments were conducted.

Data from 34 studies (65,962 patients) revealed that the most significant risk factors for post-LVAD stroke were identified as pump thrombosis (OR, 3.26; 95% confidence interval [CI], 2.32, 4.59) and infection (OR, 2.44; 95% CI, 1.81, 3.28). However, atrial fibrillation was not associated with post-LVAD stroke (OR, 0.93; 95% CI, 0.83, 1.04). Other risk factors included white race (OR, 1.09; 95% CI, 1.01, 1.18), cancer (OR, 1.61; 95% CI, 1.14, 2.27), chronic obstructive pulmonary disease (OR, 1.16; 95% CI, 1.01, 1.33), age (SMD=0.06; 95% CI, 0.01, 0.1), albumin (SMD=-0.44; 95% CI, -0.80, -0.09), diabetes (OR, 1.22; 95% CI, 1.04, 1.44), peripheral vascular disease (OR, 1.21; 95% CI, 1.04, 1.39), and international normalized ratio (SMD=-0.10; 95% CI, -0.19, -0.01).

This study further revealed a series of risk factors associated with post-LVAD stroke, as well as differences in risk factors in the new device era. These findings provide a basis for clinical device selection and precision interventions, aiding in the focused identification and reduction of post-LVAD stroke risk.

International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42024617821.