Risk factors for neurological complications and clinical outcomes in patients with left ventricular assist devices

Abstract

Objectives: Patients with left ventricular assist devices (LVADs) frequently experience cerebrovascular complications. We investigated the complications, including intracra-nial hemorrhage (ICH) and ischemic stroke (IS), in patients with LVADs. Methods: A historical cohort study was performed at an emergency clinic including patients who underwent LVAD placement between February 16, 2015, and April 1, 2020. Of the 295 patients with LVADs, 71 (24.1%) were admitted to the emergency service between the study dates because of IS and ICH. Electronic medical files were reviewed, and patients were categorized as ICH or IS. Results: Of the included patients, 245 (83.0%) were male. The most common postoperative complications were pump thrombosis (26.8%, n = 79), blood culture positivity (19.3%, n = 57), and surgical bleeding (5.8%, n = 17). The most frequent LVAD indication was ischemic dilated cardiomyopathy (71.5%, n = 211). The mean age was 49.6 ± 16.7 and 51.3 ± 14.8 years for patients with and without neurological complications, respectively (P = 0.415). Neurological complications were seen in 65 (31.3%) patients with and in 6 (6.9%) patients without coronary ischemia (P < 0.001). Neurological complications were found in 39 (30.5%) patients with an implantable cardioverter defibrillator (ICD) and in 32 (19.2%) patients without an ICD (P = 0.024). Neurological complications were found in 19 (61.3%) patients with and in 52 (19.7%) patients without a history of stroke (P < 0.001). Logistic regression analysis revealed that age and Glasgow coma scale (GCS) were the only significant variables independently affecting mortality status. While a younger age was a protective factor, a one-unit increase in the GCS was associated with a 4.1-fold (95% CI: 1.308-13.071) increase in mortality. Conclusions: Coronary ischemia, ICD, cerebrovascular disease, and smoking significantly affected the presence of complications. Moreover, patients with combined IS and ICH had a lower chance of recovering. Interventional procedures should be performed as early as possible, especially in elderly patients with a low GCS.