Cerebrovascular Injury During Left Ventricular Assist Device Support and Neurologic Outcomes After Cardiac Transplant
Aaron Shoskes1, Catherine Hassett1, Merry Huang1, Randall Starling2, Sung-Min Cho3, Ken Uchino1
1Neurological Institute, 2Heart and Vascular Institute, Cleveland Clinic, 3Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University
Objective:

To determine whether patients who developed left ventricular assist device (LVAD) associated cerebrovascular complications had higher rates of mortality or neurology morbidity after undergoing heart transplantation than those who did not suffer a stroke during LVAD support.

Background:

LVADs can support patients with refractory heart failure as a bridge to heart transplant but are associated with ischemic and hemorrhagic stroke complications. Patients who undergo heart transplantation after LVAD-associated stroke have not been previously characterized.

Design/Methods:

We reviewed consecutive adult patients undergoing LVAD implantation at a tertiary care center between 2004 to 2021 to identify patients who underwent subsequent cardiac transplantation. All patients with LVAD were reviewed to find those who developed ischemic and hemorrhagic stroke during LVAD support. Post-transplantation outcomes including mortality and incidence of ischemic or hemorrhagic stroke were compared between patients who had an LVAD-associated stroke and those who did not.

Results:

Of 1014 patients who underwent LVAD implantation, 206 developed cerebrovascular injury during LVAD support including 115 ischemic strokes and 91 hemorrhagic strokes. 273 LVAD patients underwent heart transplantation including 25 patients who had suffered stroke (19 ischemic and 6 hemorrhagic). Patients with LVAD-associated stroke were less likely to undergo subsequent transplantation than those without stroke (12% vs 31%, p<0.001). Only one patient with LVAD-associated cerebrovascular injury had a subsequent stroke within two years after transplant (4%) compared to 11 patients (4.5%) without LVAD-associated cerebrovascular injury (p=1.0). No patients with LVAD-associated stroke injury died within two years of cardiac transplant compared with 24 patients (10%) without this history (p=0.10).

Conclusions:

Despite the high morbidity and mortality of LVAD-associated stroke, select patients may be able to undergo cardiac transplantation and post-transplant neurologic and mortality outcomes do not differ from patients who did not suffer LVAD-associated stroke.