Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation

Xuereb, L.; Go, Pauline H.; Kaur, Babbaljeet; Akrawe, Silvy; Nemeh, Hassan; Borgi, Jamil; Williams, C.; Paone, Gaetano; Morgan, Jeffrey A.

doi:10.1016/j.athoracsur.2016.04.025

Cited by 27 publications

(12 citation statements)

References 32 publications

(30 reference statements)

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“…(11,26) We did not find a history of atrial arrhythmias to be a predictor for stroke. Therefore, data don’t support routine intensification of anticoagulation or adjunctive procedures such as left atrial appendage ligation or Maze procedure during LVAD implant in patients with atrial fibrillation.…”

Section: Discussionmentioning

confidence: 63%

INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices

Acharya

Loyaga‐Rendon

Morgan

et al. 2017

JACC: Heart Failure

148

137

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Objectives We sought to evaluate predictors of stroke on LVAD from data available prior to implantation, and quantify stroke-related morbidity and mortality Background Stroke is a major complication after LVAD. Pre-implant factors that influence stroke are not well understood. Methods We evaluated all patients in the INTERMACS registry who were implanted with continuous-flow LVADs from May 1, 2012 to March 31, 2015. Preoperative risk factors for stroke, and stroke incidence, morbidity, and mortality were analyzed. Results During the study period, 7112 patients underwent CF LVAD placement. Median follow-up was 9.79 months (range 0.02–34.96 months). Of all patients, 752 (10.57%) had at least one stroke, with an incidence rate of 0.123 strokes per patient-year. 447 (51.38%) strokes were ischemic and 423 (48.62%) were hemorrhagic. Patients with hemorrhagic stroke had worse survival than those with ischemic strokes (30-day survival 45.3% vs. 80.7, p <0.001). Of patients with a first stroke, 13% had a second stroke. Pre-implant predictors of stroke were female gender (HR 1.51, 95% CI 1.25–1.82, p <0.001), pre-implant systolic blood pressure (HR 1.01, 95% CI 1.00–1.01, p = 0.002), heparin-induced thrombocytopenia (HIT) (HR 3.68, 95% CI 1.60–8.47, p = 0.002), intra-aortic balloon pump (IABP) (HR 1.21, 95% CI 1.01–1.46, p = 0.043), and primary cardiac diagnosis (ischemic/other/unknown) (p = 0.040). Conclusion Despite improvements in LVAD technology, stroke-related morbidity and mortality is substantial. Further investigation is necessary to decrease the risk of this devastating complication.

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Section: Discussionmentioning

confidence: 63%

INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices

Acharya

Loyaga‐Rendon

Morgan

et al. 2017

JACC: Heart Failure

148

137

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“…To explain an increase in the mortality rate of AF group, we also looked at the incidence of right heart failure among the study population. There is no significant difference in perioperative/postoperative right heart failure incidence between AF and non‐AF groups in three studies . Interestingly, among those studies, Oezpeker and team also reported a significantly higher incidence of right heart failure as a cause of death in AF group compared to NAF group (21.4% vs. 10.2%).…”

Section: Discussionmentioning

confidence: 85%

“…There is no significant difference in perioperative/postoperative right heart failure incidence between AF and non-AF groups in three studies. 14,17,18 Interestingly, among those studies, Oezpeker and team 14 also reported a significantly higher incidence of right heart failure as a cause of death in AF group compared to NAF group Another interesting observation is that only certain subtypes of atrial fibrillation are associated with an increased mortality rate in this population. In a multivariate regression analysis, Enriquez et al 13 found that persistent AF is an independent predictor for a composite endpoint of death or heart failure hospitalization.…”

Section: Discussionmentioning

confidence: 90%

“…Two studies reported an incidence of concomitant valvular heart surgery with LVAD implantation. Xuereb et al reported that 12.8% of patients with AF and 9.3% of patients with NAF had concomitant aortic valve replacement or repair. In the study by Xia et al, 3.8% of patients with AF and 4.4% of patients with NAF had concomitant aortic valve replacement or repair.…”

Section: Resultsmentioning

confidence: 99%

“…Another study was excluded because it did not provide adequate information to calculate a risk ratio. 11 Seven retrospective observational studies published between 2013 and 2018 [12][13][14][15][16][17][18] were included in this metaanalysis as shown in Table 1. Most of the studies examined patients undergoing LVAD implantation in the United States except for one study which was conducted in Europe (Germany).…”

Section: Resultsmentioning

confidence: 99%

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Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

et al. 2019

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Atrial fibrillation (AF) is a common finding in patients evaluated for left ventricular assist device (LVAD). There is conflicting data regarding the mortality risk as well as the thromboembolic risk in patients with preoperative AF who undergo LVAD implantation. We examined these risks by performing a meta‐analysis. We performed a literature search of Pubmed, EMBASE, SCOPUS, and Cochrane from inception to February 2018. The eligible studies were used to compare mortality rate and thromboembolic risk between AF and Non‐AF (NAF) groups after LVAD implantation. We obtained 391 articles from our search strategy. Seven retrospective studies were included and accounted for 5823 LVAD patients (AF 1589; NAF 4234). The median follow‐up duration ranged from 7–24 months. The pooled analysis revealed a significantly increased risk of mortality in preoperative AF patients who underwent LVAD operation compared to those with NAF (Risk Ratio [RR] 1.16, 95% CI 1.05‐1.28, I2 = 0%). Five studies reported thromboembolism events involving 1359 preoperative AF and 3893 NAF patients. The pooled analysis did not show a statistically significant association between risk of thromboembolic event and preoperative AF (Risk Ratio [RR] 1.08, 95% CI 0.86‐1.36, I2 = 76.2%). Our study shows that preoperative AF may be associated with a higher mortality rate. This study is limited by the fact that the data are pooled from retrospective studies. Further prospective studies are warranted in order to validate these results.

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Prevention and Treatment of Thrombotic and Hemorrhagic Complications in Patients Supported by Continuous-Flow Left Ventricular Assist Devices

Loyaga‐Rendon

Jani

Fermin

et al. 2017

Curr Heart Fail Rep

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Left ventricular assist devices (LVADs) are now widely used for the management of end-stage heart failure. Unfortunately, in spite of the indisputable positive impact LVADs have on patients, the frequency and severity of complications are limitations of this therapy. Stroke, pump thrombosis, and gastrointestinal bleeding are among the most serious and frequent complications in these patients. The balance between hemorrhagic and thrombotic complications in patients supported with CF-LVAD is difficult as most patients do not necessarily fit a "bleeder" or a "clotter" profile but rather move from one side to the other of the thrombotic/bleeding spectrum. Further research is necessary to better understand the risk factors and mechanisms involved in the development of these complications.

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Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation

Cited by 27 publications

References 32 publications

INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices

INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices

Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

Prevention and Treatment of Thrombotic and Hemorrhagic Complications in Patients Supported by Continuous-Flow Left Ventricular Assist Devices

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