Cerebrovascular Accident in a Patient with Left Ventricular Assist Device and Therapeutic INR: Should Left Atrial Appendage Be Routinely Closed?

Abstract

discovered with advanced imaging modalities such as computed tomography (CT) of the chest. Conclusion: Calcified apical aneurysms can develop in patients with ICMP and advanced CHF and should always be looked for before LVAD implantation. Advanced imaging techniques, such as CT of the chest, can help to identify such calcified aneurysms preoperatively and safely tailor surgical plans in these patients.

Atrial arrhythmias in patients with left ventricular assist devices

“…This can reduce atrial fibrillation in long-term in some LVAD patients. Despite other improvements in left atrial parameters, preliminary evidence suggests that the left atrial appendage continues to have contractile dysfunction and may be a site of thrombosis despite mechanical unloading and anticoagulation with LVAD implantation [17][18][19][20][21][22][23][24]. Significant valvular disease can also persist in some patients and is associated with higher atrial pressures, atrial dilation, and early hospitalization and death [11,12].…”

“…Although initial studies suggested that a history of atrial fibrillation was associated with increased risk of thromboembolism after LVAD, the majority of subsequent studies have demonstrated no increased risk of thromboembolic or bleeding events [2 ■■ ,5,6,7 ■ ,8,9, [17][18][19][20]. Though this data is heterogeneous with variable definitions of atrial fibrillation, differing anticoagulation and antiplatelet practices, and inclusion of different LVAD pump types, in totality it implies that the inherent thrombogenicity of LVAD therapy makes the contribution of atrial fibrillation to thromboembolic risk marginal.…”

“…Anticoagulation is critical in patients with atrial arrhythmias, and LVAD which requires close follow-up and management to diminish the risk of thromboembolic events and LVAD thrombus. However, left atrial appendage occlusion during LVAD implantation surgery decreases thromboembolic events and therefore, can be considered in patient who has pre-LVAD atrial fibrillation or AFL [18][19][20]. However, there are several areas that need to be investigated for better evidenced base management decisions.…”