Cerebrovascular complications associated with the use of artificial circulatory support services

Neurologic complications are associated with the use of total artificial hearts and with ventricular support systems. Among these complications, thromboembolic events are the most severe and the most frequent, resulting from flow disturbances associated with the artificial devices or occurring within the artificial heart. However, alterations in blood viscosity, abnormalities in the coagulation system, and infection all may play a part in the generation of thrombi. Anticoagulation may play a role in controlling the events that lead to thromboembolism, but the most effective therapeutic regimen has yet to be defined. Although neurologic complications constitute a significant risk, disabling strokes have been relatively rare and appear to relate to the duration of support on the device. The majority of subjects who sustained device-related strokes have made an excellent recovery following transplantation. LVADs constitute an important therapeutic development in the treatment of end stage heart failure. They may cause neurologic complications, but they have the capability of sustaining life until a suitable donor heart is found.