Acute Operative Intervention for Intracranial Hemorrhage in Adult Patients with Ventricular Assist Device Therapy Associated with Fatal Outcomes

Abstract

Objective: Ventricular assist devices (VADs) are utilized more frequently in the management of patients with advanced heart failure due to benefits in survival and quality of life. Intracranial hemorrhagic injuries (HI) are a significant source of morbidity and mortality in VAD patients. The aim of this investigation was to describe prognostic variables in VAD patients with HI, describe the outcomes after neurosurgical intervention, and find indications for surgery. Methods: The records of 160 patients who underwent VAD implantation from 2007 to 2011 were retrospectively analyzed. Data was abstracted to identify risk factors for the development of HI. Premorbid patient data and demographics were considered. Risk factors for increased mortality were investigated within the HI group. Detailed investigations were performed on patients undergoing operative intervention. Results: Twenty-three HIs were identified in 23 of the 156 VAD patients. A prior history of stroke and increased length of VAD therapy were found to be risks for HI. The 30-day mortality after HI was 69.6%. A presenting GCS 30mL, and increasing cerebral midline shift were significant risk factors for increased 30-day mortality. Six of 7 patients undergoing surgery died within the immediate post-operative period. The lone surviving patient underwent delayed operative intervention 11 days after HI. Conclusion: Despite improvements in morbidity with VAD implantation and survival after implant, HI remains a significant source of morbidity. This study has identified several potential risks for the development of HI and for increased mortality after HI. Acute operative interventions for HI were found to have limited success.