Cerebrovascular Events in Pediatric Population on Intracorporeal Continuous-Flow Ventricular Assist Devices: Single Center Experience

Abstract

Continuous flow intracorporeal left ventricular assist devices(CF-LVAD) are used more frequently in pediatric population. One of the major complications of CF-LVAD includes cerebrovascular events(CVE) and little is known about this complication in pediatric patients. We performed a retrospective, single center review of 21 patients younger than 19 years of age who underwent CF-LVAD implantation between June 2014 and September 2018. Patients on biventricular support, extracorporeal device were excluded. Cerebrovascular accidents-ischemic or hemorrhagic-were investigated. CVE was confirmed by brain computed tomographic scan. Target international normalized ratio was 2.0-3.0. Of twenty-one pediatric patients, 11 was male. Mean BSA was 1.05±0.41(0.77-1.78) m2 and mean age was 11.05±4.07 years. Dilated cardiomyopathy was the leading cause of heart failure. The patients were implanted HeartWare hVAD (Heartware Ltd, Framingham, MA, USA n=19), Heartmate II(Thoratec Corp., Pleasanton, CA, USA n=1) and Heartmate III (n=1). Mean follow-up time was 421±448(18-1460) days. Nine(43%) patients underwent transplantation, 1 patient recovered with subsequent device explantation. Four(17%) patients were still on support. One patient(5%) died in early postoperative period and 6(28%) patients died on VAD support after mean duration of 194 days. There were overall 5 cerebral hemorrhagic strokes in 4 patients(0.2 events per patient-year). CVA occurred between 250 and 1320 days(mean 600 days). No ischemic stroke was documented. Only one(20%) patient died after hemorrhagic stroke; other 3 patients recovered and were discharged from the hospital with minor sequelaes. Incidence of CVE in children on CF-LVAD is relatively low compared with adults on VAD and severity of stroke is milder than adult population.