Significance of Prior Stroke on Outcomes after LVAD-BTT

Abstract

Background Strokes are a devastating complication following left ventricular assist device (LVAD). The purpose of this study was to determine if a cerebral vascular accident (CVA) prior to LVAD placement in a bridge-to-transplant population is associated with worse outcomes compared to those without a history of prior CVA. Methods De-identified data were obtained from TRAVIATA (TransAtlantic Registry on VAD and Transplant) a retrospective, observational, multinational registry that included candidates for heart or heart and kidney transplant in whom an LVAD was implanted between January 2008 and April 2017. Only individuals greater than 15 years old who were implanted with either an HVAD (HeartWare, Minnesota, MN, USA) or a Heartmate II (HM2, Abbott, Pleasanton) were included (N=524). Patients were stratified into those with a CVA prior to LVAD ((+)CVA, n=55) and those without a CVA prior to LVAD ((-)CVA, n=469). The primary outcome was survival to transplant. Other outcomes of interest included death on support and post-LVAD CVA. Multivariable regression was performed in order to assess the simultaneous effect of multiple risk factors on transplant. Results The only difference between the preoperative characteristics studied between the study groups was a higher frequency of non-whites in those who had a CVA pre-LVAD (Table1). There were no differences in rates of transplant, death on support, or post-LVAD CVA between the study groups (Table2). In multivariable analysis, older age, higher BMI and preoperative DM were associated with decreased likelihood of transplant. Of interest, in those who were transplanted, time to transplant was longer in the (+)CVA group compared to the (-)CVA group (Table 2). Conclusions Stroke prior to LVAD was not associated with worse outcomes after LVAD, including decreased survival to transplant, death or stroke post-LVAD.