Cerebral Embolization During Left Ventricular Assist Device Implantation is Linked to Early Right Ventricular Failure

To evaluate the impact of air introduction into the left ventricular (LV) cavity and right coronary artery (RCA) during durable left ventricular assist device (dLVAD) implantation on the incidence of early right heart failure (RHF) within 7 postoperative days, specifically to investigate whether the quantity of air emboli, as detected by transcranial Doppler (TCD) monitoring, correlates with an increased risk of early RHF.

This single-center retrospective analysis involved intraoperative TCD monitoring of the middle cerebral arteries. Between January 2021 and April 2024, 62 cases of dLVAD implantations (all of them HeartMate3) were performed, 59 of which were eligible for inclusion in the statistical analysis. TCD recorded high-intensity transient signals (HITS), indicative of emboli. Based on the number of intraoperative HITS, 2 categories were created: minimal-mild (<2,500 HITS; group A) and moderate-severe (>2,500 HITS; group B).

A single-center retrospective chart review.

Patients who received dLVAD implantation under TCD surveillance.

A retrospective chart review of patients receiving standard of care; no study interventions were performed.

In group A, 9 out of 40 patients (22.5%) experienced early postoperative RHF. In contrast, 14 out of 19 patients (73.7%) in Group B developed early RHF, indicating a strong statistical significance (P < .001). A statistically significant difference was also demonstrated in postoperative 30-day all-cause mortality; there were no deaths (0% mortality) in group A, whereas in group B, 4 out of 19 patients (21.1%) died within 30 days (p = 0.01).

The presence of >2,500 intraoperative HITS was correlated with a higher incidence of complications in the postoperative period. TCD monitoring during dLVAD implantation may be a potential tool to monitor for RV dysfunction.