Optimization of Left Ventricle Size After VAD Implantation Prevents Incidence of Cerebral Infarction

Abstract

<h3>Purpose</h3> Stroke after ventricular assist device (VAD) implantation is a critical complication. Previous studies have noted the distance between the inflow cannula and the left ventricular (LV) septum, as well as an angulation of the inflow cannula from the apical axis, related to the incidence of stroke. In the early phase after VAD implantation, diuresis is caused by improved renal blood flow, furthermore, rapid volume reduction of LV greatly changes circulating plasma volume, resulting in increased stroke risk; however, little is known about an appropriate indicator for the prevention of this phenomenon. The aim of this study is to analyze the relationship between LV size optimization and the incidence of stroke after VAD implantation. <h3>Methods</h3> Forty patients who underwent continuous-flow LVAD implantation from March 2011 to May 2020 at our hospital were enrolled and divided into the stroke and non-stroke groups. Left ventricular diastolic diameter (LVDd) shown by transthoracic echocardiography, a value of serum brain natriuretic peptide (BNP), cardiothoracic ratio (CTR) in chest X-ray findings, and the ratio of change of these parameters 1 month after implantation were retrospectively evaluated. <h3>Results</h3> As for device selection for 40 patients, EVAHEART in 25, HeartMateII in 6, Jarvik2000 in 4, HVAD in 4, and HeartMate3 in 2 were used. Nine patients were in the stroke group and the remaining 31 were in the non-stroke groups. Pre- and post-operative values for LVDd, BNP, CTR, and ratio of change of these parameters were shown below. The ratio of change in LVDd and BNP 1 month after implantation was significantly greater in the stroke group. <h3>Conclusion</h3> Optimization of left ventricle size based on the ratio of change of LVDd and BNP in the early phase after VAD implantation might prevent the incidence of stroke.