Abstract WP415: Prevalence Of Cerebrovascular Events In Patients With Left Ventricular Assist Device - Continuous Flow And Pulsatile Flow Devices Compared
Background: A continuous flow left ventricular assist device (c-LVAD) provides a better clinical outcome for patients with severe heart failure than pulsatile flow LVAD (p-LAVD). However, the frequency of cerebrovascular events, crucial complications, is largely unknown, especially in patients with systemic infection. We examined the prevalence of stroke related to systemic infection in patients with these 2 LVAD types.
Methods: We reviewed 114 consecutive patients (c-LVAD group: n=47, 66.6 patient-years; p-LVAD group: n=67 patients, 63.5 patient-years) who received LVAD support at Osaka University Hospital from 2005-2012. Cerebrovascular complications were defined as a neurological deficit concomitant with a coinciding lesion shown by computed tomography. Anticoagulation was given according to the manufacturer’s recommendation. Stroke frequency was compared between the groups.
Results: During LVAD support, 8 patients (c-LVAD, 1; p-LVAD, 7) died from stroke. As for cerebral infarctions, 10 events in 5 patients occurred in the c-LVAD group and 29 in 23 in p-LVAD (0.15 vs. 0.46 events/patient-year, p=0.02). For intracranial hemorrhage including cerebral parenchymal and subarachnoid hemorrhage, 21 events in 16 patients occurred in the c-LVAD group and 30 in 23 in p-LVAD (0.31 vs. 0.47 events/patient-year, P=0.15). The prevalence of ICH was 0.05%/patient-day in patients without systemic infection. In contrast, those in the c-LVAD group had a bloodstream infection develop into ICH as follows: 0.67%/patient-day within 2 weeks, 0.39%/patient-day from 2-4 weeks, 0.13%/ patient-day more than 4 weeks after bloodstream infection, while those were 0.67%, 0.24%, and 0.04%, respectively, in the p-LVAD group.
Conclusions: Continuous flow LVAD decreases cerebral infarction frequency, though ICH frequency remains poor. Notably, even in c-LVAD group, bloodstream infection elevates ICH risk in the acute phase and its frequency was almost similar with p-LVAD group. Careful management of anticoagulation is also required for patients with continuous flow LVAD especially in acute phase of blodd stream infection.
- © 2012 by American Heart Association, Inc.