Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Bhimaraj, Arvind; Uribe, César; Suarez, E.E.

doi:10.14797/mdcj-11-1-12

Cited by 16 publications

(15 citation statements)

References 57 publications

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“…This acquired von Willebrand syndrome is reversible after LVAD explantation. Apart from the thrombogenic nature and the acquired VW syndrome, it is possible that continuous blood flow has a deleterious effect on the autoregulation of cerebral microcirculation, which results in both ischemic and hemorrhagic strokes …”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Minimal invaziv cerrahi prosedürleri uygulanarak ya da kardiyopulmoner baypas pompası kullanılmadan cihazların yerleştirilmesi mümkün hale gelmiştir (Tablo 19). [304] Günümüzde 3. Kuşak yeni nesil pompalar gerek kalıcı gerekse köprü amaçlı kullanılmaktadır.…”

Section: Günümüzde Yaygın Olarak Kullanılan Cihazlar Nelerdir?unclassified

İleri evre kalp yetersizliği rehberi

Nalbantgil¹,

Çavuşoğlu²,

Akdeniz³

et al. 2018

updates cardiol

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Bu dergide kullanılan kağıt ISO 9706: 1994 standardına uygundur. (Permanence of Paper) National Library of Medicine biyomedikal yayın organlarında asitsiz kağıt (acid-free paper / alkalin kağıt) kullanılmasını önermektedir.Bu eser bilime katkı amacı ile Medtronic'in koşulsuz desteği ile hazırlanmıştır. İçeriğindeki tüm görüş ve iddialar editörlerin ve yazarların kendilerine ait olup, Medtronic ile ilişkilendirilemez.

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“…It has also been shown that AVO status does not correlate with clinically significant arteriovenous malformations [48]. Furthermore, it should be considered that the typical VAD patient with GIB (advanced age, mainly ischemic cause of heart failure, diabetes, anticoagulation therapy [49 & ,50]) would be on enhanced risk for GIB even without a pump.…”

Section: Gastrointestinal Bleeding and Coagulation Disturbancesmentioning

confidence: 99%