Relationship Between Bacteremia and Hemorrhagic Stroke in Patients With Continuous-Flow Left Ventricular Assist Device

Yoshioka, Daisuke; Sakaniwa, Ryoto; Toda, Köichi; Samura, Takaaki; Saito, Shunsuke; Koibuchi, Noriyuki; Okazaki, Shuhei; Domae, Keitaro; Yoshikawa, Yasushi; Miyagawa, Shigeru; Iso, Hiroyasu; Sakata, Yasushi; Sawa, Yoshiki

doi:10.1253/circj.cj-17-0541

Cited by 34 publications

(25 citation statements)

References 18 publications

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“…Ischemic and hemorrhagic strokes are potentially devastating complications of LVAD therapy, with hemorrhagic strokes portending worse morbidity and mortality 66,88,89 . Risk factors for stroke include active infection, 90–93 sub‐ or supratherapeutic anticoagulation, 66,89,90,93,94 female sex, 71,88 increased blood pressure, 66,88,89,91,95 renal dysfunction, 96 tobacco use, 91 peripheral vascular disease, 89 chronic obstructive pulmonary disease 96 and diabetes 71,94 …”

Section: Hemocompatibility Eventsmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

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Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure, yet still require concomitant medications in order to achieve the best possible clinical outcomes. Since the outset of routine placement of durable, continuous‐flow LVADs, much of the medication management of these patients to date has been based on International Society of Heart and Lung Transplantation (ISHLT) guidance, most recently published in 2013. Since 2013, numerous multidisciplinary pharmacotherapy publications have increased the LVAD community's understanding of best practices with respect to medications. We identified the major domains of LVAD medication management and conducted a comprehensive search of US National Library of Medicine MEDLINE® database using keywords chosen to identify medication‐related publications of significance dated 2013 or later. Trials pertaining to the HeartMate II™ and the HeartMate™ 3 LVADs (Abbott, Chicago, IL) and the HeartWare™ HVAD™ System (Medtronic, Minneapolis, MN) were chosen for inclusion. Highest priority for inclusion was given to prospective, randomized, controlled studies. Absent these, controlled trials (retrospective or prospective observational) were given next‐highest consideration, followed by retrospective uncontrolled studies, and finally case series. Reference lists of qualified publications were reviewed to find any other publications of interest that were not discovered on initial search. Case reports were generally excluded, except where the insight gained was deemed to be uniquely pertinent. This document serves to provide a comprehensive review of the current understanding of optimal medication management in patients with durable, continuous‐flow LVADs.

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Section: Hemocompatibility Eventsmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

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“…In their report, the majority of BSI were caused by Staphylococci (CNS, MRSA). Yoshioka et al found a similar association with hemorrhagic stroke in patients with either bacteremia or pump pocket infection [56,57].…”

Section: Cerebrovascular Microbleeds/stroke/mycotic Aneurysmmentioning

confidence: 87%

“…Fortunately with infection control techniques, rates of driveline infections appear to be decreasing [82]. Pocket infections are less common but can confer greater risks of morbidity including hemorrhagic stroke [56,57]. In a large prospective study of infections after cardiac operations, Perrault et al found that LVAD and transplant patients experienced 5.8 times higher rates of mediastinal infections (95% CI 2.36-14.33) with five times higher readmission and mortality rates [83].…”

Section: Outcomes In Lvad Infectionsmentioning

confidence: 99%

Left Ventricular Assist Device Infections

Skalweit¹

2018

Advanced Concepts in Endocarditis

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Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplantation vs. transplant is necessary, combined with extended antimicrobial therapy.

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“…[67][68][69] Infections affect morbidity, mortality, and heart transplantation in LVAS patients. 16,70,71 Several reports have shown the association of infections with stroke, 9,20,23,55,65,68,[70][71][72] and the INTERMACS analysis showed a significant effect for infections on stroke, 14 although the temporal and causal relationship has not been well established in all studies. Acute infections can be seen in more than half of the patients with AIS.…”

Section: Infectionsmentioning

confidence: 99%

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

et al. 2021

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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.

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Relationship Between Bacteremia and Hemorrhagic Stroke in Patients With Continuous-Flow Left Ventricular Assist Device

Cited by 34 publications

References 18 publications

Pharmacotherapy for durable left ventricular assist devices

Pharmacotherapy for durable left ventricular assist devices

Left Ventricular Assist Device Infections

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

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