TY - JOUR
T1 - Stroke After Left Ventricular Assist Device Implantation
T2 - Outcomes in the Continuous-Flow Era
AU - Harvey, Laura
AU - Holley, Christopher
AU - Roy, Samit S.
AU - Eckman, Peter
AU - Cogswell, Rebecca
AU - Liao, Kenneth
AU - John, Ranjit
N1 - Publisher Copyright:
© 2015 by The Society of Thoracic Surgeons.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background. Left ventricular assist devices (LVADs) are increasingly used in patients with heart failure. To study the impact of stroke on clinical outcomes after continuous-flow (CF-) LVAD implantation, we evaluated our single-center experience. Methods. From 2006 to 2013, we implanted the HeartMate II CF-LVAD in 230 patients. We used standard statistical methods to evaluate our results. Results. Of our study group, 185 patients (80.4%) received the CF-LVAD as a bridge to transplantation. Strokes occurred in a total of 39 patients (17%), an incidence rate of 0.064 strokes per person-year: 19 (48.7%) were embolic, and 20 (51.3%) were hemorrhagic. The stroke-free rate at 6 months after HeartMate II implantation was 92.6%, at 12 months, 89.6%, and at 24 months, 86.1%. Baseline demographic characteristics did not differ significantly, except that stroke patients had a lower incidence of coronary artery disease (p = 0.004) and prior cardiac surgery (p = 0.001). We noted a trend toward an increased risk of stroke in patients with CF-LVAD-related infections (p = 0.053). The survival rate in stroke (versus stroke-free) patients at 6 months was 84.6% (versus 84.2%); at 12 months, 71.8% (versus 81.6%); and at 24 months, 53.9% (versus 74.7%; p = 0.0019). During a median follow-up time of 761 days, mortality risk in stroke patients was 2.01 times that of stroke-free patients (hazard ratio = 2.01; p = 0.004). Conclusions. Stroke while on CF-LVAD support was associated with significant mortality. To reduce the risk of stroke, it is essential to further elucidate risk factors, to optimize anticoagulation, and to further understand the impact of LVAD-related infections.
AB - Background. Left ventricular assist devices (LVADs) are increasingly used in patients with heart failure. To study the impact of stroke on clinical outcomes after continuous-flow (CF-) LVAD implantation, we evaluated our single-center experience. Methods. From 2006 to 2013, we implanted the HeartMate II CF-LVAD in 230 patients. We used standard statistical methods to evaluate our results. Results. Of our study group, 185 patients (80.4%) received the CF-LVAD as a bridge to transplantation. Strokes occurred in a total of 39 patients (17%), an incidence rate of 0.064 strokes per person-year: 19 (48.7%) were embolic, and 20 (51.3%) were hemorrhagic. The stroke-free rate at 6 months after HeartMate II implantation was 92.6%, at 12 months, 89.6%, and at 24 months, 86.1%. Baseline demographic characteristics did not differ significantly, except that stroke patients had a lower incidence of coronary artery disease (p = 0.004) and prior cardiac surgery (p = 0.001). We noted a trend toward an increased risk of stroke in patients with CF-LVAD-related infections (p = 0.053). The survival rate in stroke (versus stroke-free) patients at 6 months was 84.6% (versus 84.2%); at 12 months, 71.8% (versus 81.6%); and at 24 months, 53.9% (versus 74.7%; p = 0.0019). During a median follow-up time of 761 days, mortality risk in stroke patients was 2.01 times that of stroke-free patients (hazard ratio = 2.01; p = 0.004). Conclusions. Stroke while on CF-LVAD support was associated with significant mortality. To reduce the risk of stroke, it is essential to further elucidate risk factors, to optimize anticoagulation, and to further understand the impact of LVAD-related infections.
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U2 - 10.1016/j.athoracsur.2015.02.094
DO - 10.1016/j.athoracsur.2015.02.094
M3 - Article
C2 - 26070599
AN - SCOPUS:84938738180
SN - 0003-4975
VL - 100
SP - 535
EP - 541
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -