74 Pre- and Post-Operative Risk Factors Associated with Neurological Complications in Patients Supported by Ventricular Assist Device

Abstract

Purpose Neurological complications (NC) are a major adverse event following left ventricular assist device (LVAD) surgery. Pre- and post-operative factors associated with NC were investigated. Methods and Materials We reviewed 287 consecutive patients who underwent LVAD surgery [167 Heart Mate (HM) I and 121 HM II] at Columbia University Medical Center between November 2000 and June 2010. Clinical characteristics, hemodynamic and laboratory indexes were analyzed. The NC was defined according to the INTERMACS definition of neurological dysfunction including transient ischemic attack (TIA) and ischemic or hemorrhagic stroke. Results In total, 43 (15.0%) patients developed NC at 145±218 days after surgery, including 28 infarcts, 5 hemorrhages, and 14 TIAs. Six patients developed multiple events. The type of NC was not different between HM I and HM II patients. Preoperative factors that were different between patients with and without NC included: serum albumin (pre-alb, 3.3±0.6 vs. 3.5±0.5 mg/dL; p=0.015); sodium (pre-Na, 127±9 vs. 132±8 mg/dL, p=0.001), and the history of stroke (pre-stroke, 37.2% vs. 17.1%, p=0.003). Postoperative factors associated with NC again included lower albumin (post-alb, 3.4±0.7 vs. 3.9±0.7 mg/dL, p=0.001); sodium (post-Na, 128±8 vs. 132±7 mg/dL, p=0.003) and hematocrit (post-Hct, 31.8±6.1 vs. 35.3±6.6 %, p=0.001). The incidence of LVAD-related infection (post-Inf) was higher (39.5% vs. 20.8%, p=0.008) in patients with NC than without NC. Multiple regression analysis revealed that pre-stroke [odds ratio (OR) 3.0, 95% confidential interval (CI), 1.2-7.3, p=0.002], post-Na (OR, 0.9, 95%CI, 0.90-0.99, p=0.002), and post-Infect (OR, 2.9, 95%CI, 1.24-6.67, p=0.001) were highly associated with NC development. The combination of pre-Alb, pre-stroke, post-Alb, post-Na, post-Hct and post-Inf could predict NC with a probability of 76.4%. Conclusions Persistent malnutrition, severity of heart failure, previous stroke and post LVAD infections were the key factors associated with NC development post LVAD.