OBJECTIVE: A cerebrovascular accident is a devastating adverse event in a patient with a ventricular assist device. The goal was to clarify the risk factors for cerebrovascular accident. METHODS: Prospectively collected data, including medical history, ventricular assist device type, white blood cell count, thrombelastogram, and infection, were reviewed retrospectively in 124 patients. RESULTS: Thirty-one patients (25%) had 48 cerebrovascular accidents. The mean ventricular assist device support period was 228 and 89 days in patients with and without cerebrovascular accidents, respectively (P < .0001). Sixty-six percent of cerebrovascular accidents occurred within 4 months after implantation. Actuarial freedom from cerebrovascular accident at 6 months was 75%, 64%, 63%, and 33% with the HeartMate device (Thoratec Corp, Pleasanton, Calif), Thoratec biventricular ventricular assist device (Thoratec Corp), Thoratec left ventricular assist device (Thoratec), and Novacor device (WorldHeart, Oakland, Calif), respectively. Twenty cerebrovascular accidents (42%) occurred in patients with infections. The mean white blood cell count at the cerebrovascular accident was greater than the normal range in patients with infection (12,900/mm3) and without infection (9500/mm3). The mean maximum amplitude of the thrombelastogram in the presence of infection (63.6 mm) was higher than that in the absence of infection (60.7 mm) (P = .0309). CONCLUSIONS: The risk of cerebrovascular accident increases with a longer ventricular assist device support period. Infection may activate platelet function and predispose the patient to a cerebrovascular accident. An elevation of the white blood cell count may also exacerbate the risk of cerebrovascular accident even in patients without infection. Selection of device type, prevention of infection, and meticulous control of anticoagulation are key to preventing cerebrovascular accident.
OBJECTIVE: A cerebrovascular accident is a devastating adverse event in a patient with a ventricular assist device. The goal was to clarify the risk factors for cerebrovascular accident. METHODS: Prospectively collected data, including medical history, ventricular assist device type, white blood cell count, thrombelastogram, and infection, were reviewed retrospectively in 124 patients. RESULTS: Thirty-one patients (25%) had 48 cerebrovascular accidents. The mean ventricular assist device support period was 228 and 89 days in patients with and without cerebrovascular accidents, respectively (P < .0001). Sixty-six percent of cerebrovascular accidents occurred within 4 months after implantation. Actuarial freedom from cerebrovascular accident at 6 months was 75%, 64%, 63%, and 33% with the HeartMate device (Thoratec Corp, Pleasanton, Calif), Thoratec biventricular ventricular assist device (Thoratec Corp), Thoratec left ventricular assist device (Thoratec), and Novacor device (WorldHeart, Oakland, Calif), respectively. Twenty cerebrovascular accidents (42%) occurred in patients with infections. The mean white blood cell count at the cerebrovascular accident was greater than the normal range in patients with infection (12,900/mm3) and without infection (9500/mm3). The mean maximum amplitude of the thrombelastogram in the presence of infection (63.6 mm) was higher than that in the absence of infection (60.7 mm) (P = .0309). CONCLUSIONS: The risk of cerebrovascular accident increases with a longer ventricular assist device support period. Infection may activate platelet function and predispose the patient to a cerebrovascular accident. An elevation of the white blood cell count may also exacerbate the risk of cerebrovascular accident even in patients without infection. Selection of device type, prevention of infection, and meticulous control of anticoagulation are key to preventing cerebrovascular accident.
Authors: Athanasios Tsiouris; Gaetano Paone; Hassan W Nemeh; Jamil Borgi; Celeste T Williams; David E Lanfear; Jeffrey A Morgan Journal: World J Cardiol Date: 2015-11-26
Authors: Kimberly Y Lin; Basavaraj Kerur; Char M Witmer; Lauren A Beslow; Daniel J Licht; Rebecca N Ichord; Beth D Kaufman Journal: Cardiol Young Date: 2013-09-09 Impact factor: 1.093
Authors: Amelia K Boehme; Salpy V Pamboukian; James F George; T Mark Beasley; James K Kirklin; Jose Tallaj; Chrisly Dillon; Emily B Levitan; Russell Griffin; Gerald McGwin; William B Hillegass; Nita A Limdi Journal: ASAIO J Date: 2017 Nov/Dec Impact factor: 2.872
Authors: Angelo Nascimbene; Ruben Hernandez; Joggy K George; Anita Parker; Angela L Bergeron; Subhashree Pradhan; K Vinod Vijayan; Andrew Civitello; Leo Simpson; Maria Nawrot; Vei-Vei Lee; Hari R Mallidi; Reynolds M Delgado; Jing Fei Dong; O H Frazier Journal: J Heart Lung Transplant Date: 2014-01-19 Impact factor: 10.247
Authors: Elizabeth A Genovese; Mary Amanda Dew; Jeffrey J Teuteberg; Marc A Simon; Joy Kay; Michael P Siegenthaler; Jay K Bhama; Christian A Bermudez; Kathleen L Lockard; Steve Winowich; Robert L Kormos Journal: Ann Thorac Surg Date: 2009-10 Impact factor: 4.330