Risk of Stroke in Patients with Left Ventricular Assist Device Who Had Myocardial Recovery

Abstract

<h3>Purpose</h3> The risk factors and incidence rates of stroke after implantation of left ventricular assist devices (LVAD) are well established. Little is known about the factors associated with stroke after LVAD explantation in patients who have had a myocardial recovery. <h3>Methods</h3> A single center retrospective study conducted between 2014-2019 for patients with myocardial recovery and subsequent LVAD explantation. We studied their demographics, clinical & laboratory data, echocardiographic, and invasive hemodynamic data to explore any possible associative factors predictive of stroke in the future. <h3>Results</h3> A total of 17 patients were identified with myocardial recovery while having an LVAD in place. Group 1 with no stroke (15 patients) and group 2 with stroke (2 patients).The mean age of patient at explant was 52.2 years in group 1 and 51.3 years for group 2, while mean duration of LVAD was 14.8 months for group 1 vs. 18.5 months for group 2.Majority of patients were women (59%) and main cause of heart failure was non ischemic cardiomyopathy (88%). There were 10 HeartMate 2 devices (HM 2), 3 HeartMate 3 (HM 3) devices, and 4 HeartWare (HVAD) Ventricular Assist Devices. There was no statistical difference in term of risk factors (DM, HTN, CAD, arrhythmia, CKD, smoking) between the two groups. However patients who had stroke had a trend of subtherapeutic INR and uptrending LDH with infection of the retained pump. In term of echo data, patient in group 2 had more evidence of RV dysfunction and abnormal inflow cannula position (figure 1). <h3>Conclusion</h3> Traditional risk factors e.g. subtherapeutic INR and pro-thrombotic states (like infection) along with echocardiographic features e.g. abnormal inflow cannula position and degree of RV dysfunction are among the main reasons for stroke in patients with myocardial recovery while having an LVAD in place.