Outcomes in Patients With Symptomatic Cerebrovascular Disease Undergoing Heart Transplantation

Patlolla, Vishnu; Mogulla, Vanajakshi; DeNofrio, David; Konstam, Marvin A.; Krishnamani, Rajan

doi:10.1016/j.jacc.2011.04.038

Cited by 29 publications

(19 citation statements)

References 22 publications

(11 reference statements)

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“…Our findings of high mortality associated with ICH compared to other samples 6,10 , is likely due to the methods by which ICH was defined and captured. In our study we excluded patients with subdural and epidural hematoma where the primary inciting process would be trauma rather than a process intrinsic to the cerebral circulation.…”

Section: Discussionmentioning

confidence: 60%

“…The reported incidence of stroke after continuous flow (CF)-LVAD across a variety of studies ranges from 12.1 to 28.7% 1–5 . Stroke is a leading cause of mortality in LVAD and a contraindication for cardiac transplantation in several centers 6 . The risk factors for stroke have been well characterized and include among others blood pressure, infection, pump thrombosis, gastrointestinal bleeding and insufficient or excessive anti-thrombotic treatment 7–9 .…”

Section: Introductionmentioning

confidence: 99%

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Outcomes after stroke complicating left ventricular assist device

Willey¹,

Gavalas²,

Trinh³

et al. 2016

The Journal of Heart and Lung Transplantation

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Background Stroke is one of the leading complications during continuous flow-left ventricular assist device (CF-LVAD) support. Risk factors have been well described, though less is known regarding treatment and outcomes. We present a large single center experience on stroke outcome and transplant eligibility by stroke subtype and severity in CF-LVAD patients. Methods 301 patients underwent CF-LVAD (266 HeartMate II (HM II) and 35 HeartWare (HVAD)) between 1/1/2008 and 4/1/2015. Stroke was defined as a focal neurological deficit with abnormal neuroimaging. Intracerebral hemorrhage (ICH) definition excluded subdural hematoma and hemorrhagic conversion of an ischemic stroke (IS). Treatment in IS included intra-arterial embolectomy (IAE) when appropriate; treatment in ICH included reversal of coagulopathy. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). Outcomes were in-hospital mortality and transplant status. Results 40 patients suffered a stroke: 8 ICH (4 HM II, 4 HVAD) and 32 IS (26 HM II, 6 HVAD). Among 8 ICH there were 4 deaths (50%) (NIHSS 18.8±13.7 vs 1.8±1.7 in survivors, p=0.049). Among 32 IS, 12 had hemorrhagic conversion and 5 were treated with IAE. There were 9 deaths (28%) (NIHSS 16.2±10.8 vs 7.0±7.6 in survivors, p=0.011). Among the 32 IS patients, 12 underwent transplant and 1 is awaiting transplant; no ICH patients were transplanted. Conclusions In-hospital mortality after stroke is significantly affected by the initial neurological impairment. Patients with IS appear to benefit the most from in-hospital treatment and often make sufficient recovery to be able to progress to transplant.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Outcomes after stroke complicating left ventricular assist device

Willey¹,

Gavalas²,

Trinh³

et al. 2016

The Journal of Heart and Lung Transplantation

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“…19 The occurrence of stroke can have a negative influence on the quality of life, can decrease survival, and also impact a patient's candidacy for transplantation. 20 There are limited data for predicting LVAD-associated strokes. In addition, there is no universally accepted anticoagulation protocol, which is currently based on animal experiments and expert opinions.…”

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confidence: 99%

Stroke after implantation of continuous flow left ventricular assist devices

Tsiouris

Heliopoulos

Mikroulis

et al. 2019

Journal of Cardiac Surgery

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Objective Stroke remains a frequent and devastating complication after left ventricular assist device (LVAD) implantation, despite recent advances in device technology. The aim of this study was to analyze risk factors and outcomes of stroke following implantation of 200 continuous‐flow LVADs at our institution. Methods We retrospectively analyzed patients who underwent LVAD implantation from 2011‐2016. Data were available for a total of 200 patients. Results Post‐LVAD stroke occurred in 13% of patients (26 of 200). Ischemic stroke occurred in 50% of patients (13 of 26), and hemorrhagic stroke in 50% (13 of 26). The median duration of LVAD support at the time of stroke was 257.4 days. Baseline characteristics did not differ significantly between the stroke and stroke‐free cohorts. The mean international normalized ratio (INR) at the time of embolic stroke was 1.86 (range, 1.23‐3.25) and 4.62 (range, 1.4‐21.4) in patients with hemorrhagic stroke (P = .014). Mortality within 30 days of stroke was 31% (8 of 26). Mortality for hemorrhagic stroke was 63% (5 of 8) and 37% (3 of 8) for ischemic stroke ( P = .03). Among the 18 patients that survived stroke, 28% (5 of 18) received a heart transplant, 39% (7 of 18) are receiving ongoing LVAD support, and 33% (6 of 18) have died from unrelated causes. Multivariate analysis showed that INR level, aortic cross‐clamping, a history of previous stroke, and postoperative infection were significant predictors for post‐LVAD stroke. Conclusion The occurrence of stroke significantly increases morbidity and mortality after LVAD implantation. Despite an adverse impact on survival and quality of life, several patients who suffered stroke still received a heart transplant. Furthermore, none of our patients had recurrence of a neurological event. Strict implementation of anticoagulation protocols is likely the mainstay of preventing this devastating complication.

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“…Symptomatic cerebrovascular disease should be considered a relative contraindication due to increased risk of stroke and functional Who needs a transplant and when? Chan and Ross decline [77]. Both extremes in weight such as morbid obesity and cachexia are associated with increased morbidity and mortality [78,79].…”

Section: Advances In Determining Prognosismentioning

confidence: 99%