Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro‐axial flow pump: Insights from a large registry-Reference-Cited by-同舟云学术

Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro‐axial flow pump: Insights from a large registry

Published:2024-05-27 Issue: Volume: Page:
ISSN:0160-564X
Container-title:Artificial Organs
language:en
Short-container-title:Artificial Organs

Author:

Gallone Guglielmo¹^ORCID,Lewin Daniel²³^ORCID,Rojas Hernandez Sebastian⁴,Bernhardt Alexander⁵,Billion Michael⁶,Meyer Anna⁷,Netuka Ivan⁸,Kooij J‐J⁹,Pieri Marina¹⁰,Szymanski Mariusz K.¹¹,Moeller Christian H.¹²,Akhyari Payam¹³,Jawad Khalil¹⁴,Krasivskyi Ihor¹⁵^ORCID,Schmack Bastian¹⁶,Färber Gloria¹⁷,Medina Marta¹⁸,Haneya Assad¹⁹,Zimpfer Daniel²⁰,Nersesian Gaik²²¹,Lanmueller Pia²³²¹,Spitaleri Antonio²²^ORCID,Oezkur Mehmet¹⁸,Djordjevic Ilija¹⁵^ORCID,Saeed Diyar¹⁴,Boffini Massimo²²,Stein Julia³,Gustafsson F.¹²,Scandroglio Anna Mara¹⁰,De Ferrari Gaetano Maria¹,Meyns Bart⁹,Hofmann Steffen⁶,Belohlavek Jan²³²⁴,Gummert Jan⁴,Rinaldi Mauro²²,Potapov Evgenij V.²³²¹,Loforte Antonio²²^ORCID

Affiliation:

1. City of Health and Science Hospital, Division of Cardiology, Department of Medical Sciences University of Turin Turin Italy

2. Department of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité (DHZC) Berlin Germany

3. Department of Cardiovascular Surgery Charité—Universitätsmedizin Berlin Berlin Germany

4. Heart and Diabetes Center North Rhine‐Westphalia Bad Oeynhausen Germany

5. Department of Cardiovascular Surgery University Heart Center Hamburg Hamburg Germany

6. Department of Cardiac Surgery Schüchtermann Clinic Bad Rothenfelde Germany

7. Department of Cardiac Surgery Heidelberg University Hospital Heidelberg Germany

8. Institute of Clinical and Experimental Medicine Prague Czech Republic

9. Department of Cardiac Surgery University Hospitals Leuven Leuven Belgium

10. Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy

11. Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands

12. Department of Cardiothoracic Surgery Rigshospitalet Copenhagen Denmark

13. Department of Cardiovascular Surgery University Hospital Duesseldorf Duesseldorf Germany

14. Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany

15. Department of Cardiothoracic Surgery University Hospital Cologne Cologne Germany

16. Department of Cardiac Surgery University of Essen Essen Germany

17. Department of Cardiothoracic Surgery Jena University Hospital Jena Germany

18. Department of Cardiac and Vascular Surgery University of Mainz Mainz Germany

19. Department of Cardiovascular Surgery University Hospital Schleswig‐Holstein Kiel Germany

20. Department of Surgery, Division of Cardiac Surgery Medical University of Vienna Vienna Austria

21. DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany

22. City of Health and Science Hospital, Cardiac Surgery University Unit, Department of Surgical Sciences University of Turin Turin Italy

23. Second Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

24. Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland

Abstract

AbstractBackgroundStroke after durable left ventricular assist device (d‐LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d‐LVAD with micro‐axial flow‐pump (mAFP, Abiomed) is unsettled.MethodsConsecutive patients, who underwent d‐LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d‐LVAD implantation (<60 days) and association of pre‐d‐LVAD characteristics and peri‐procedural management with a specific focus on tMCS strategies were studied.ResultsAmong 341 patients, who underwent d‐LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48–65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra‐aortic balloon pump, ECMELLA, ECMELLA at d‐LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d‐LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4–22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3–85.3, p = 0.028) and ECMELLA at d‐LVAD implantation (HR 5.0, 95% CI 1.4–18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d‐LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9–4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49–7.88, p = 0.004) stroke were associated with increased 1‐year mortality.ConclusionsAmong patients undergoing d‐LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.

Publisher

Wiley

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aor.14775

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