Abstract T P332: Despite Differences in Device Design, Anticoagulation, and Duration of Use, Pulsatile- and Continuous-Flow Left Ventricular Assist Devices Share Similar Stroke Rates and Outcomes
Background: Stroke is the primary adverse outcome in Left Ventricular Assist Devices (LVADs), not well-described in current literature. We hypothesized that pulsatile-flow devices would have worse stroke rates and outcomes than continuous devices.
Methods: This is a single-center retrospective study of all adult LVADs from 1999-2013 at the University of Utah utilizing the internal LVAD and Stroke Center databases. Complete chart review included review of all relevant outside records with no case loss. Categorical variables were computed using a χ2 test; ordinal variables via the Mann-Whitney U test.
Results: Among 52 pulsatile (47 patients) and 91 continuous (81 patients) devices, 17.3% of pulsatile and 18.7% of continuous devices had at least one stroke/TIA (p=0.84). Stroke subtypes and LVAD-specific outcomes did not vary by device. Stroke severity was higher at first stroke/TIA with a median (IQR) NIHSS of 4 (2, 11) vs. 1 (1, 2) in continuous vs. pulsatile devices (p=0.03). Despite continuous devices having nearly twice the number of overall days on device (DOD), there was no difference in median DOD until first stroke/TIA: 170 in pulsatile; 165 in continuous; p=0.56. Stroke outcomes by device were good with mRS≤2 in 71% of pulsatile and 53% of continuous devices (p=0.42). All-cause 1-year mortality was high but with only the minority due to stroke (Table 1). Neither sepsis nor pump thrombus were associated with stroke/TIA.
Conclusions: Continuous devices provide longer DOD without increased stroke risk or significantly worse outcomes. First AIS/TIA events were more severe in continuous devices, with non-significantly worse mRS scores. In this study, we did not replicate previous findings of infection predisposing to stroke.
Author Disclosures: T.M. Burton: None. E.S. Davis: None. M.J. Tanana: None. L. DeWitt: None. J.J. Wold: None. C.H. Selzman: None. J.J. Majersik: None.
- © 2014 by American Heart Association, Inc.