Predicting Outcomes of Patients with Ventricular Assist Devices Who Suffer Neurological Injuries

Abstract

Purpose Neurological injuries (Nis), both ischemic neurological injuries (INIs) and hemorrhagic neurological injuries (HNIs), are a significant source of morbidity and mortality in patients with a ventricular assist device (VAD). There is no published data that identifies prognostic risk factors in patients with VADs who suffer a NI. This study attempts to identify risk factors for increased mortality after a NI. Methods and Materials A single-institution, retrospective review of 159 consecutive patients treated with VADs from January 2007 to December 2011 was undertaken. Premorbid patient data and demographics were considered. Patients who suffered Nis and predictors of increased mortality were identified. Results Fifty-three patients (33%) suffered at least one NI (30 INIs and 18 HNIs). The 12-month mortality rates for INIs and HNIs were 63.3 and 72.2%, respectively. In INIs, male sex, longer time with a VAD, a Glasgow Coma Scale (GCS) of ≤11, and prior stroke were associated with increased 12-month mortality. A presenting GCS of ≤9, higher prothrombin time, longer time with a VAD, and prior stroke were associated with increased 12-month mortality in HNIs. The most devastating NI noted was intracerebral hemorrhage (ICH) with 70 and 90% of patients dying within 30-day and 12-month follow-up periods, respectively. Only patients with supratentorial ICHs who presented with a GCS of ≥14 and an ICH volume 3 survived longer than 30 days. When neurosurgical consults were obtained for a NI, 12-month mortality was 78.9%. Patients who underwent a neurosurgical procedure had an 87.5% 30-day mortality. Conclusions Despite improvements in both morbidity with VAD implantation and survival after implant, Nis remain a significant source of morbidity and mortality. This retrospective analysis has identified several predictors of increased mortality in patients who suffer a NI including male sex, longer time with a VAD, a presenting GCS of ≤11, and prior stroke. This information may be useful to guide prognosis.