Cerebrovascular Events After Continuous-Flow Left Ventricular Assist Devices

Abstract

LVADs are associated with high rates of CVE, increased mortality, and lower rates of heart transplantation. Further investigations to identify the optimal primary and secondary stroke prevention measures in post-LVAD patients are warranted.

A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

“…38 In the INTERMACS registry, 51.4% of strokes were primarily ischemic, with a corresponding 30-day survival rate of 80.7%. 14 Although localization and severity of AIS are rarely reported, it appears that the majority are cortical and moderate in severity, 16 with less than a third due to large vessel occlusion (LVO). 9,37 Claims of right-hemispheric predominance 39 have not been validated in other reports, 16 and can be attributed to the anatomical site of surgical anastomosis.…”

“…However, the involvement of other traditional risk factors is controversial, such as atrial fibrillation 9,14,24,41-43 and diabetes mellitus. 9,16,21,44 Although history or pre-LVAD stroke does not appear to be a risk factor for AIS occurrence after LVAD implantation, 13% of patients suffer a second stroke during LVAD support. 14 The main risk factors for AIS during LVAD support are discussed later.…”

“…Despite a lower rate of stroke in premenopausal women in the general population, female sex has been reported as an independent risk factor for stroke in LVAD patients across several studies, 14,16,18,[44][45][46] although sex was not associated with stroke in some other studies. 47,48 Hypertension LVAD patients' pulse pressure is reduced to the extent that a pulse may not be palpable via traditional means.…”

“…1 Stroke is also an independent risk factor for in-hospital mortality (hazard ratio: 6.1), 18 increased by 4 and 18 times after AIS and ICH, respectively. 19 Mortality associated with ICH is significantly higher than with AIS, 16,19,20 with overall median mortality rates of 71 and 31% for ICH and AIS, respectively. 15 Besides, the occurrence of stroke is associated with a significant decline in the rate of heart transplantation to less than half as stroke increases the risk of mortality and morbidity.…”

“…Stroke in LVAD patients is a leading cause of morbidity and mortality. 9,[14][15][16][17] Stroke accounts for almost a fifth of deaths after LVAD implantation. 9,17 One-year survival is much lower in patients with a stroke (43.7%) 14 compared with those without a stroke (80%).…”