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Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices.

Publication ,  Journal Article
Chiang, YP; Cox, D; Schroder, JN; Daneshmand, MA; Blue, LJ; Patel, CB; DeVore, AD; Bishawi, M; Milano, CA
Published in: J Card Surg
February 2020

BACKGROUND AND AIM: Stroke remains a significant complication of left ventricular assist device (LVAD) therapy. We performed a single-center retrospective study evaluating patients undergoing first-time HeartWare HVAD (Medtronic Inc) or HeartMate 3 (Abbott Inc) implantation from September 2009-February 2018. METHODS: Exclusion criteria were age <18 and preoperative ECMO. The primary endpoint was stroke-free survival. Stroke was defined as new neurological deficits persisting >24 hours with corresponding radiographic evidence. Risk factors evaluated included demographics, medical comorbidities, heart failure etiology, LVAD indication, INTERMACS profile, and device type. Univariate predictors (P < .15) and variables clinically suspected to raise stroke risk were entered in a multivariate hazard regression model, specified using backward selection of covariates and accounting for competing risks of transplant/LVAD exchange. RESULTS: A total of 163 HVAD and 84 HM3 patients were analyzed. Median follow up (until death, censoring for transplant/LVAD removal, or end of follow up) was 1.2 years in HVAD patients and 1.4 years in HM3 patients. Stroke occurred in 24 HVAD patients (15 ischemic, 9 hemorrhagic) and 6 HM3 patients (4 ischemic, 2 hemorrhagic). One-year stroke-free survival was 76.8% for HVAD and 84.3% for HM3. Thirty-day mortality following stroke was 41.7% for HVAD and 66.7% for HM3; 54.2% of HVAD strokes were disabling compared to 83.3% of HM3 strokes. Age, LVAD indication, and device type were associated (P < .15) with stroke on univariate analysis. On multivariate analysis, the HVAD was associated with significantly higher stroke risk (hazard ratio, 2.57; 95% confidence interval, 1.02-6.44; P = .045). CONCLUSIONS: Different LVAD models appear to be associated with significantly different stroke risks.

Duke Scholars

Published In

J Card Surg

DOI

EISSN

1540-8191

Publication Date

February 2020

Volume

35

Issue

2

Start / End Page

383 / 389

Location

United States

Related Subject Headings

  • Young Adult
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Prosthesis Implantation
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
 

Citation

APA
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ICMJE
MLA
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Chiang, Y. P., Cox, D., Schroder, J. N., Daneshmand, M. A., Blue, L. J., Patel, C. B., … Milano, C. A. (2020). Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices. J Card Surg, 35(2), 383–389. https://doi.org/10.1111/jocs.14397
Chiang, Yuting P., Daniel Cox, Jacob N. Schroder, Mani A. Daneshmand, Laura J. Blue, Chetan B. Patel, Adam D. DeVore, Muath Bishawi, and Carmelo A. Milano. “Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices.J Card Surg 35, no. 2 (February 2020): 383–89. https://doi.org/10.1111/jocs.14397.
Chiang YP, Cox D, Schroder JN, Daneshmand MA, Blue LJ, Patel CB, et al. Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices. J Card Surg. 2020 Feb;35(2):383–9.
Chiang, Yuting P., et al. “Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices.J Card Surg, vol. 35, no. 2, Feb. 2020, pp. 383–89. Pubmed, doi:10.1111/jocs.14397.
Chiang YP, Cox D, Schroder JN, Daneshmand MA, Blue LJ, Patel CB, DeVore AD, Bishawi M, Milano CA. Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices. J Card Surg. 2020 Feb;35(2):383–389.
Journal cover image

Published In

J Card Surg

DOI

EISSN

1540-8191

Publication Date

February 2020

Volume

35

Issue

2

Start / End Page

383 / 389

Location

United States

Related Subject Headings

  • Young Adult
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Prosthesis Implantation
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices