A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

Abstract

The use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnostic approach, and discuss treatment strategies.

Approach to patients with left ventricular assist device and its complications at the emergency department

“…Regarding blood pressure, it has been suggested previously that a MAP of 70 to 130 mmHg be maintained in the first 24 hours 29 .…”

“…With the latest devices, the risk has diminished, but has not been eliminated. Likewise, evidence of ICHs has been found regardless of the INR level, so the explanation is more than overanticoagulation 28,29 . The most common characteristic in patients with intracerebral bleeding is acquired von Willebrand syndrome 30 .…”

Atención del paciente con dispositivos de asistencia ventricular izquierda y sus complicaciones en el servicio de urgencias

“…En cuanto a la presión arterial, se ha sugerido previamente mantener una PAM entre 70 y 130 mmHg en las primeras 24 horas 29 .…”

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

“…Ischemic and hemorrhagic strokes are a relatively common LVAD complication that occurs at a rate of 0.08 to 0.27 events per patient per year [ 43 ]. In this patient population, a stroke can be devastating and is associated with worse outcomes and lower chance of receiving a heart transplant within the subgroup of BTT patients [ 44 , 45 ].…”

“…However, other LVAD-specific factors have been reported to further increase this risk. For instance, ischemic strokes in LVAD patients originate not only from atherosclerotic disease, but also from embolization of thrombi formed in the LVAD itself, outflow graft, intracardiac chambers, or aortic root [ 43 , 46 , 47 ]. Therefore, optimizing the LVAD speed to allow for intermittent aortic valve opening and maintaining therapeutic anticoagulation in addition to antiplatelet therapy are key to reducing thrombus formation.…”