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Original Research

Open Access

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

  • Meltem Songur Kodik1
  • Ali Kemal Yildiz2
  • Ilhan Uz1
  • Sercan Yalçinli1
  • Umit Kahraman3
  • Elif Bolat4
  • Ayşe Guler5
  • Cenk Eraslan6
  • Yusuf Ali Altunci7

1Emergency Physician at Ege University, School of Medicine, Department of Emergency Medicine, 35100 Izmir, Turkey

2Assistant Doctor at Ege University, School of Medicine, Department of Emergency Medicine, 35100 Izmir, Turkey

3Cardiovascular surgeon at Ege University, School of Medicine, Department of Cardiovascular Surgery, 35100 Izmir, Turkey

4Neursurgeon at Ege University, School of Medicine, Department of Neurosurgery, 35100 Izmir, Turkey

5Associate Professor of Neurology at Ege University, School of Medicine, Department of Neurology, 35100 Izmir, Turkey

6Associate Professor of Neuroradiology at Ege University, School of Medicine, Department of Radiology, 35100 Izmir, Turkey

7Assistant Professor at Ege University, School of Medicine, Department of Emergency Medicine, 35100 Izmir, Turkey

DOI: 10.22514/sv.2020.16.0114 Vol.17,Issue 1,January 2021 pp.143-151

Published: 08 January 2021

*Corresponding Author(s): Meltem Songur Kodik E-mail: songurm@yahoo.com

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.

Keywords

Left ventricular assist devices; Neurological complication; Stroke; Age; Glasgow coma scale

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Meltem Songur Kodik,Ali Kemal Yildiz,Ilhan Uz,Sercan Yalçinli,Umit Kahraman,Elif Bolat,Ayşe Guler,Cenk Eraslan,Yusuf Ali Altunci. Risk factors for neurological complications and clinical outcomes in patients with left ventricular assist devices. Signa Vitae. 2021. 17(1);143-151.

References

[1] McMurray JJ, Petrie MC, Murdoch DR, Davie AP. Clinical epidemiology of heart failure: public and private health burden. European Heart Journal. 1999; 19: P9-16.

[2] Ho KKL, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. Journal of the American College of Cardiology. 1993; 22: A6-A13.

[3] Cleveland JC Jr, Naftel DC, Reece TB, Murray M, Antaki J, Pagani FD, et al. Survival after biventricular assist device implantation: an analysis of the Interagency Registry for Mechanically Assisted Circulatory Support database. Journal of Heart and Lung Transplantation. 2011; 30: 862-869.

[4] Goodwin K, Kluis A, Alexy T, John R, Voeller R. Neurological complications associated with left ventricular assist device therapy. Expert Review of Cardiovascular Therapy. 2019; 16: 909-917.

[5] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Van-denbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International Journal of Surgery. 2014; 12: 1495-1499.

[6] ICD-10-CM coma, stroke codes require more specific documentation. JustCoding News Inpatient. 2012.

[7] What is the glasgow coma scale? BrainLine. 2018. Available at: https: //www.brainline.org/article/what-glasgow-coma-scale (Accessed: 1 November 2020).

[8] Teasdale G, Jennett B. Assessment of coma and impaired consciousness. The Lancet. 1974; 304: 81-84.

[9] Lu J, Marmarou A, Lapane K, Turf E, Wilson L. A method for reducing misclassification in the extended Glasgow Outcome Score. Journal of Neurotrauma. 2010; 27: 843-852.

[10] van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988; 19: 604-607.

[11] Tahir RA, Rotman LE, Davis MC, Dupépé EB, Kole MK, Rahman M, et al. Intracranial hemorrhage in patients with a left ventricular assist device. World Neurosurgery. 2018; 113: e714-e721.

[12] Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010; 137: 263-72.

[13] NIH Stroke Scale. National Institute of Neurological Disorders and Stroke. 2020. Available at: https://www.ninds.nih.gov/sites/default/files/NIH_Stroke_Scale_Booklet.pdf (Accessed: 1 November 2020).

[14] Hurst JW, Morris DC, Alexander RW. The use of the New York Heart Association’s classification of cardiovascular disease as part of the patient’s complete problem list. Clinical Cardiology. 1999; 22: 385-390.

[15] Hurst JW, Morris DC, Alexander RW. The use of the New york heart association’s classification of cardiovascular disease as part of the patient’s complete problem list. Clinical Cardiology. 1999; 22: 385-390.

[16] LeQuang J, Magnusson P, Pergolizzi J. Implantable cardioverter-defibrillator therapy at end of life: a commentary. Heart and Mind. 2019; 3: 31.

[17] Willey JZ, Gavalas MV, Trinh PN, Yuzefpolskaya M, Reshad Garan A, Levin AP, et al. Outcomes after stroke complicating left ventricular assist device. The Journal of Heart and Lung Transplantation. 2018; 35: 1003-1009.

[18] Frontera JA, Starling R, Cho S, Nowacki AS, Uchino K, Hussain MS, et al. Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices. The Journal of Heart and Lung Transplantation. 2018; 36: 673-683.

[19] Cantillon DJ, Tarakji KG, Kumbhani DJ, Smedira NG, Starling RC, Wilkoff BL. Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator. Heart Rhythm. 2010; 7: 466-471.

[20] Boyle AJ, Jorde UP, Sun B, Park SJ, Milano CA, Frazier OH, et al. Pre-operative risk factors of bleeding and stroke during left ventricular assist device support: an analysis of more than 900 HeartMate II outpatients. Journal of the American College of Cardiology. 2014; 63: 880-888.

[21] Morris AA, Pekarek A, Wittersheim K, Cole RT, Gupta D, Nguyen D, et al. Gender differences in the risk of stroke during support with continuous-flow left ventricular assist device. The Journal of Heart and Lung Transplantation. 2015; 34: 1570-1577.

[22] Bogaev RC, Pamboukian SV, Moore SA, Chen L, John R, Boyle AJ, et al. Comparison of outcomes in women versus men using a continuous-flow left ventricular assist device as a bridge to transplantation. The Journal of Heart and Lung Transplantation. 2011; 30: 515-522.

[23] Harvey L, Holley C, Roy SS, Eckman P, Cogswell R, Liao K, et al. Stroke after Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era. The Annals of Thoracic Surgery. 2015; 100: 535-541.

[24] Teuteberg JJ, Slaughter MS, Rogers JG, McGee EC, Pagani FD, Gordon R, et al. The HVAD left ventricular assist device: risk factors for neurological events and risk mitigation strategies. JACC: Heart Failure. 2016; 3: 818-828.

[25] Jorde UP, Aaronson KD, Najjar SS, Pagani FD, Hayward C, Zimpfer D, et al. Identification and management of pump thrombus in the heartware left ventricular assist device system. JACC: Heart Failure. 2015; 3: 849-856.

[26] Shao IY, Elkind MS V, Boehme AK. Bloodstream infections. Journal of the American Heart Association. 2019; 50: 1046-1051.

[27] Olsen A. Cognitive control function and moderate-to-severe traumatic brain injury: functional and structural brain correlates. 2014.

[28] Hohnloser SH, Duray GZ, Baber U, Halperin JL. Prevention of stroke in patients with atrial fibrillation: current strategies and future directions. European Heart Journal Supplements. 2008; 10: H4-H10.

[29] Fussner J, Velasco, C. Stroke coordinator boot camp assessing stroke-scores & scales. 2019. https://www.heart.org/-/media/files/affiliates/gra/gra-qsi/2019-scbc-presentations/5--assessing-stroke--scores--scales-v2. pdf?la=en&hash=ED3F9267A585CFDE7514E8D9A8180B07E0BECA6.

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