INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices: Risk Factors and Outcomes.

Academic Article

Abstract

  • OBJECTIVES: This study sought to evaluate predictors of stroke during left ventricular assist device (LVAD) support from data available prior to implantation, and quantify stroke-related morbidity and mortality. BACKGROUND: Stroke is a major complication after LVAD. Pre-implant factors that influence stroke are not well understood. METHODS: We evaluated all patients in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) who were implanted with continuous flow LVADs from May 1, 2012, to March 31, 2015. Pre-operative risk factors for stroke and stroke incidence, morbidity, and mortality were analyzed. RESULTS: During the study period, 7,112 patients underwent continuous flow LVAD placement. Median follow-up was 9.79 months (range 0.02 to 34.96 months). Of all patients, 752 (10.57%) had at least 1 stroke, with an incidence rate of 0.123 strokes per patient-year. A total of 447 (51.38%) strokes were ischemic and 423 (48.62%) were hemorrhagic. Patients with hemorrhagic stroke had worse survival than those with ischemic strokes (30-day survival: 45.3% vs. 80.7%; p < 0.001). Of patients with a first stroke, 13% had a second stroke. Pre-implant predictors of stroke were female sex (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: 1.25 to 1.82; p < 0.001), pre-implant systolic blood pressure (HR: 1.01; 95% CI: 1.00 to 1.01; p = 0.002), heparin-induced thrombocytopenia (HR: 3.68; 95% CI: 1.60 to 8.47; p = 0.002), intra-aortic balloon pump (HR: 1.21; 95% CI: 1.01 to 1.46; p = 0.043), and primary cardiac diagnosis (ischemic/other/unknown) (p = 0.040). CONCLUSIONS: Despite improvements in LVAD technology, stroke-related morbidity and mortality is substantial. Further investigation is necessary to decrease the risk of this devastating complication.
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    Keywords

  • left ventricular assist device, stroke, Adult, Aged, Aged, 80 and over, Anticoagulants, Blood Pressure, Brain Ischemia, Cerebral Hemorrhage, Female, Heart Failure, Heart-Assist Devices, Heparin, Humans, Incidence, Intra-Aortic Balloon Pumping, Male, Middle Aged, Postoperative Complications, Proportional Hazards Models, Prosthesis Implantation, Registries, Risk Factors, Sex Factors, Stroke, Thrombocytopenia, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Acharya D; Loyaga-Rendon R; Morgan CJ; Sands KA; Pamboukian SV; Rajapreyar I; Holman WL; Kirklin JK; Tallaj JA
  • Start Page

  • 703
  • End Page

  • 711
  • Volume

  • 5
  • Issue

  • 10