Risk of stroke early after implantation of a left ventricular assist device.

Abstract

Stroke is one of the major adverse events after left ventricular assist device implantation. Risk of stroke is the highest immediately after left ventricular assist device implantation and then increases again in chronic periods. There is no study that has analyzed risk factors for stroke in acute phase. We investigated the risk factors for stroke in the acute phase after left ventricular assist device implantation in the present study. Between October 2005 and December 2016, 158 consecutive patients (mean age, 43 ± 14 years; 34% were women) underwent continuous-flow left ventricular assist device (50 HeartMate II [Abbott Medical, Abbott Park, Ill], 38 DuraHeart [Terumo Heart, Ann Arbor, Mich], 33 Jarvik2000 [Jarvik Heart, New York, NY], 23 EVAHEART [Sun Medical, Moriyama City, Japan], 14 HeartWare [Framingham, Mass]) implantation in our institution. We analyzed the risk factors for a symptomatic stroke within 90 days after left ventricular assist device implantation. Stroke occurred in 28 patients in the acute phase after left ventricular assist device implantation. Multivariate analysis revealed that low cardiac output (odds ratio, 0.25; 0.07-0.92; P = .024) during postoperative 12 to 24 hours was the only independent risk factor for stroke in the acute phase. Patients with stroke in the acute phase had higher serum lactate dehydrogenase levels at any point until postoperative 14 days. Patients with the HeartMate II device particularly showed a statistically significant negative relationship between cardiac output during postoperative 12 to 24 hours and serum lactate dehydrogenase levels at postoperative 14 days (r = -0.313, P = .03). Our study demonstrated that patients with perioperative lower cardiac output and higher lactate dehydrogenase level developed stroke in the acute phase after left ventricular assist device implantation. These results suggested that maintenance of sufficient left ventricular assist device flow is important in prevention of stroke, which may be related to subclinical pump thrombosis.