Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices. Issue 2 (6th December 2019)

• Record Type: Journal Article
• Authors: Chiang, Yuting P.; Cox, Daniel; Schroder, Jacob N.; Daneshmand, Mani A.; Blue, Laura J.; Patel, Chetan B.; DeVore, Adam D.; Bishawi, Muath; Milano, Carmelo A.
• Is Part Of: Journal of cardiac surgery. Volume 35:Issue 2(2020)
• Page Start: 383
• Page End: 389
• Publication Date: 2019-12-06
• Subjects: Left ventricular assist device -- Stroke -- Cardiovascular research; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.14397
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background and Aim: Stroke remains a significant complication of left ventricular assist device (LVAD) therapy. We performed a single‐center retrospective study evaluating patients undergoing first‐time HeartWare HVAD (Medtronic Inc) or HeartMate 3 (Abbott Inc) implantation from September 2009‐February 2018. Methods: Exclusion criteria were age <18 and preoperative ECMO. The primary endpoint was stroke‐free survival. Stroke was defined as new neurological deficits persisting >24 hours with corresponding radiographic evidence. Risk factors evaluated included demographics, medical comorbidities, heart failure etiology, LVAD indication, INTERMACS profile, and device type. Univariate predictors ( P < .15) and variables clinically suspected to raise stroke risk were entered in a multivariate hazard regression model, specified using backward selection of covariates and accounting for competing risks of transplant/LVAD exchange. Results: A total of 163 HVAD and 84 HM3 patients were analyzed. Median follow up (until death, censoring for transplant/LVAD removal, or end of follow up) was 1.2 years in HVAD patients and 1.4 years in HM3 patients. Stroke occurred in 24 HVAD patients (15 ischemic, 9 hemorrhagic) and 6 HM3 patients (4 ischemic, 2 hemorrhagic). One‐year stroke‐free survival was 76.8% for HVAD and 84.3% for HM3. Thirty‐day mortality following stroke was 41.7% for HVAD and 66.7% for HM3; 54.2% of HVAD strokes were disabling compared to 83.3% of HM3 strokes. Age, LVAD indication, and device type were associated ( P < .15) with stroke on univariate analysis. On multivariate analysis, the HVAD was associated with significantly higher stroke risk (hazard ratio, 2.57; 95% confidence interval, 1.02‐6.44; P = .045). Conclusions: Different LVAD models appear to be associated with significantly different stroke risks.