Stroke on Mechanical Support: Similar Survival but Higher Risk of Stroke Post-Transplant

Abstract

Ventricular assist devices (VADs) increase waitlist survival, yet the risk of stroke is not trivial. There is a knowledge gap regarding the impact of these strokes on heart transplant outcomes. We sought to analyze how strokes during VAD support impact post-transplant (post-Tx) outcomes in children. 520 pediatric (<18 y) heart transplant patients listed from January 2011-April 2018 with a VAD implant date were matched between the United Network of Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) databases. Patients were divided into pre-Tx stroke and no stroke cohorts. The pre-Tx stroke cohort had a stroke diagnosis and neuroimaging between VAD implant and transplant, waitlist removal or death. The date of stroke was estimated using neuroimaging dates. Overall, there were 146 (28%) VAD patients with a pre-Tx stroke; 86 (59% of stroke patients) of them were transplanted at a median of 57 [17-102] days from stroke, significantly lower than the no stroke cohort (90%; p<0.001). There was no difference in post-Tx survival between the two cohorts (Fig). For the stroke patients that were transplanted, the patients who died < 1 year after transplant trended towards a shorter time between stroke and transplant (median 32 vs 60.5 days; p=0.18). The pre-Tx stroke cohort was also more likely to have a post-Tx stroke (18.6% vs 2.7%; p<0.001). Among the pre-Tx stroke cohort, patients who experienced post-Tx stroke trended to have shorter time from stroke to transplant (median 21 vs 60 days; p=0.10). Patients with stroke on VAD once transplanted, enjoy similar survival compared to no stroke patients. Allowing children who suffer stroke while on VAD support to have more time to recover appears to improve post-Tx outcomes.