Format

Send to

Choose Destination
JACC Heart Fail. 2015 Oct;3(10):818-28. doi: 10.1016/j.jchf.2015.05.011.

The HVAD Left Ventricular Assist Device: Risk Factors for Neurological Events and Risk Mitigation Strategies.

Author information

1
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: teutebergjj@upmc.edu.
2
University of Louisville, Louisville, Kentucky.
3
Duke University, Durham, North Carolina.
4
Loyola University, Chicago, Illinois.
5
University of Michigan, Ann Arbor, Michigan.
6
Northwestern University, Evanston, Illinois.
7
University of Pennsylvania, Philadelphia, Pennsylvania.
8
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
9
St. Vincent's Hospital, Indianapolis, Indiana.
10
Montefiore Hospital, Bronx, New York.
11
Cleveland Clinic, Cleveland, Ohio.
12
Indiana University, Bloomington, Indiana.
13
Florida Hospital Transplant Institute, Orlando, Florida.
14
Washington University, St. Louis, Missouri.
15
Columbia University, New York, New York.
16
HeartWare, Framingham, Massachusetts.

Abstract

OBJECTIVES:

The purpose of this study was to determine the risk factors for ischemic in hemorrhage cerebrovascular events in patients supported by the HeartWare ventricular assist device (HVAD).

BACKGROUND:

Patients supported with left ventricular assist devices are at risk for both ischemic and hemorrhagic cerebrovascular events.

METHODS:

Patients undergoing implantation with a HVAD as part of the bridge-to-transplant trial and subsequent continued access protocol were included. Neurological events (ischemic cerebrovascular accidents [ICVAs] and hemorrhagic cerebrovascular accidents [HCVAs]) were assessed, and the risk factors for these events were evaluated in a multivariable model.

RESULTS:

A total of 382 patients were included: 140 bridge-to-transplant patients from the ADVANCE (Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure) clinical trial and 242 patients from the continued access protocol. Patients had a mean age of 53.2 years; 71.2% were male, and 68.1% were white. Thirty-eight percent had ischemic heart disease, and the mean duration of support was 422.7 days. The overall prevalence of ICVA was 6.8% (26 of 382); for HCVA, it was 8.4% (32 of 382). Pump design modifications and a protocol-driven change in the antiplatelet therapy reduced the prevalence of ICVA from 6.3% (17 of 272) to 2.7% (3 of 110; p = 0.21) but had a negligible effect on the prevalence of HVCA (8.8% [24 of 272] vs. 6.4% [7 of 110]; p = 0.69). Multivariable predictors of ICVA were aspirin ≤81 mg and atrial fibrillation; predictors of HCVA were mean arterial pressure >90 mm Hg, aspirin ≤81 mg, and an international normalized ratio >3.0. Eight of the 30 participating sites had established improved blood pressure management (IBPM) protocols. Although the prevalence of ICVA for those with and without IBPM protocols was similar (5.3% [6 of 114] vs. 5.2% [14 of 268]; p = 0.99), those with IBPM protocols had a significantly lower prevalence of HCVA (1.8% [2 of 114] vs. 10.8% [29 of 268]; p = 0.0078).

CONCLUSIONS:

Anticoagulation, antiplatelet therapy, and blood pressure management affected the prevalence of cerebrovascular events after implantation of the HVAD. Attention to these clinical parameters can have a substantial impact on the occurrence of serious neurological events. (Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure [ADVANCE]; NCT00751972).

KEYWORDS:

CVA; VAD; cerebrovascular event; heart failure; stroke; ventricular assist device

PMID:
26450000
DOI:
10.1016/j.jchf.2015.05.011
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center