Risk factors for stroke on left ventricular assist devices

BackgroundPatients with end-stage heart failure on left ventricular assist devices (LVADs) are predisposed to a high incidence of stroke. Preoperative factors associated with increased stroke risk are poorly understood. MethodsWe performed a single-center retrospective review of all patients from 2009 to 2014 in whom a rotary flow LVAD was implanted. All patients with symptoms of a cerebrovascular event underwent a non-contrast head computed tomography scan. Logistic regression was used to determine factors associated with stroke both on univariate and multivariable analysis. ResultsA total of 390 patients were retrospectively analyzed and of those 61 (15.6%) had a stroke at an average follow-up of 3.51.6 years. The majority were male (72%) and were treated a priori as destination therapy (73%). The proportion of patient receiving a centrifugal flow pump was 23% compared to 77% receiving an axial flow pump. For those patients who experienced a stroke and then died, the average time from stroke to death was 158 +/- 296 days. Of the 61 patients who had a stroke, 38 (62%) died (P<0.001 compared to death rate without a stroke). On Cox regression analysis, a history of cerebrovascular accident (CVA), hyperlipidemia, and history of venous thromboembolism (VTE) were independently associated with stroke while on LVAD support. ConclusionPostoperative stroke after LVAD implantation was associated with higher mortality. A history of previous CVA, VTE, and hyperlipidemia were independently associated with stroke while on LVAD support.