Cerebrovascular events in children on intracorporeal continuous‐flow left ventricular assist devices. Issue 12 (15th August 2020)

• Record Type: Journal Article
• Authors: Sert, Dogan Emre; Kocabeyoglu, Sinan Sabit; Kervan, Umit; Karahan, Mehmet; Beyazal, Osman Fehmi; Akdi, Mustafa; Yilmaz, Abdulkadir; Catav, Zeki
• Is Part Of: Artificial organs. Volume 44:Issue 12(2020)
• Page Start: 1251
• Page End: 1258
• Publication Date: 2020-08-15
• Subjects: mechanical circulatory support -- pediatric heart failure -- stroke; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13778
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: Continuous‐flow intracorporeal left ventricular assist devices (CF‐LVAD) are used more frequently in the pediatric population. One of the major complications of CF‐LVAD is cerebrovascular events (CVEs). Limited information is available on this complication in pediatric patients. We hereby present our experience on CVEs in children under CF‐LVAD support in our institution. A retrospective, single center review of 21 patients younger than 19 years of age who underwent CF‐LVAD implantation between June 2014 and September 2018 was performed. Patients on biventricular support and extracorporeal devices were excluded. Cerebrovascular accidents (CVAs)—ischemic or hemorrhagic—were investigated. CVE was confirmed by brain computed tomographic scan. Of 21 pediatric patients, 11 were male. Mean BSA was 1.05 ± 0.41 m 2 and mean age was 11.05 ± 4.07 years. Dilated cardiomyopathy was the leading cause of heart failure. The patients were implanted with HeartWare hVAD ( n = 19), HeartMate II ( n = 1), and HeartMate 3 ( n = 1). Mean support time was 421 ± 448 (18‐1460) days. Target international normalized ratio was between 2.5 and 3.0. Nine (43%) patients underwent transplantation, one patient recovered with subsequent device explantation. Four (17%) patients were still on support. One patient (5%) died in the early postoperative period and six (28%) patients died on VAD support after a mean duration of 194 days. There were overall five cerebral hemorrhagic strokes in four patients (0.2 events per patient‐year). CVA occurred between 250 and 1320 days (mean 600 days). No ischemic stroke was documented. Only one (20%) patient died after hemorrhagic stroke; the other three patients recovered and were discharged from the hospital with minor sequelae. Incidence of CVE in children on CF‐LVAD is relatively low compared with adults on VAD and severity of stroke is milder than adult population.