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

  • Chiang, Yuting P1
  • Cox, Daniel2
  • Schroder, Jacob N1
  • Daneshmand, Mani A3
  • Blue, Laura J1
  • Patel, Chetan B4
  • DeVore, Adam D4
  • Bishawi, Muath1
  • Milano, Carmelo A1
  • 1 Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
  • 2 Duke University School of Medicine, Durham, North Carolina.
  • 3 Division of Cardiothoracic Surgery, Department of Surgery, Emory University Hospital, Atlanta, Georgia. , (Georgia)
  • 4 Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Published Article
Journal of Cardiac Surgery
Wiley (Blackwell Publishing)
Publication Date
Dec 06, 2019
DOI: 10.1111/jocs.14397
PMID: 31808964


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. 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. 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). Different LVAD models appear to be associated with significantly different stroke risks. © 2019 Wiley Periodicals, Inc.

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