Presence of Left Atrial or Left Ventricular Thrombus at the Time of CF-LVAD Implantation is Associated with Increased Post-Operative Risk of Stroke or Death

Abstract

Purpose Patients with advanced HF are at increased risk for intra-cardiac thrombus formation. The impact of pre-existing left atrial (LA) or left ventricular (LV) thrombi on post-operative outcomes in LVAD patients is unknown. Methods We retrospectively reviewed 376 patients who underwent HeartMate II LVAD implantation from February 2009 through August 2018 at a single large volume center. Transthoracic echocardiography (TTE) within 1 month of implant, intra-operative transesophageal echocardiography (TEE), and operative reports were reviewed to identify patients with pre-existing LA (including appendage) or LV thrombus at the time of LVAD implantation. We assessed the composite endpoint of stroke and death at 6 months and 2 years. Results Of the 376 patients (age 57±13 years, 81% male, 47% ICM), 26 (6.9%) had a pre-existing thrombus (13 in LA and 15 in LV). Incidence of stroke at 6 months was 23% in patients with intracardiac thrombi and 9% in patients without intracardiac thrombi (p=0.02). Incidence of stroke at 2 years was 23% in patients with intracardiac thrombi and 14% in patients without intracardiac thrombi (p=0.22). Notably all strokes occurred in the first 6 months of device support in patients with intra-cardiac thrombi. Patients were significantly more likely to die or have a stroke in the first 6 months of device support if they had pre-existing intracardiac thrombi (HR (95%CI): 2.7 (1.4, 5.2), p Conclusion Pre-existing LA or LV thrombus is associated with decreased survival free of stroke following CF-LVAD implantation which may have important implications for patient selection and management.