TY - JOUR
T1 - Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump
T2 - Insights from a large registry
AU - Gallone, Guglielmo
AU - Lewin, Daniel
AU - Rojas Hernandez, Sebastian
AU - Bernhardt, Alexander
AU - Billion, Michael
AU - Meyer, Anna
AU - Netuka, Ivan
AU - Kooij, J. J.
AU - Pieri, Marina
AU - Szymanski, Mariusz K.
AU - Moeller, Christian H.
AU - Akhyari, Payam
AU - Jawad, Khalil
AU - Krasivskyi, Ihor
AU - Schmack, Bastian
AU - Färber, Gloria
AU - Medina, Marta
AU - Haneya, Assad
AU - Zimpfer, Daniel
AU - Nersesian, Gaik
AU - Lanmueller, Pia
AU - Spitaleri, Antonio
AU - Oezkur, Mehmet
AU - Djordjevic, Ilija
AU - Saeed, Diyar
AU - Boffini, Massimo
AU - Stein, Julia
AU - Gustafsson, F.
AU - Scandroglio, Anna Mara
AU - De Ferrari, Gaetano Maria
AU - Meyns, Bart
AU - Hofmann, Steffen
AU - Belohlavek, Jan
AU - Gummert, Jan
AU - Rinaldi, Mauro
AU - Potapov, Evgenij V.
AU - Loforte, Antonio
N1 - Publisher Copyright:
© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
PY - 2024/10
Y1 - 2024/10
N2 - Background: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled. Methods: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied. Results: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48–65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4–22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3–85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4–18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9–4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49–7.88, p = 0.004) stroke were associated with increased 1-year mortality. Conclusions: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.
AB - Background: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled. Methods: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied. Results: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48–65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4–22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3–85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4–18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9–4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49–7.88, p = 0.004) stroke were associated with increased 1-year mortality. Conclusions: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.
KW - bridge strategy
KW - impella
KW - left ventricular assist device
KW - micro-axial flow pump
KW - outcomes
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85194873075&partnerID=8YFLogxK
U2 - 10.1111/aor.14775
DO - 10.1111/aor.14775
M3 - Article
C2 - 38803239
AN - SCOPUS:85194873075
SN - 0160-564X
VL - 48
SP - 1168
EP - 1179
JO - Artificial Organs
JF - Artificial Organs
IS - 10
ER -