Theresa Elder1, Alankrita Raghavan2, Arvin Smith2, Christina Huang Wright3, James Wright4, Christopher Burant5, Martha Sajatovic6, Alan Hoffer3. 1. Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. 2. School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. 3. Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. 4. Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. Electronic address: James.Wright@uhhospitals.org. 5. Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. 6. Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Abstract
BACKGROUND: Intracranial hemorrhage (ICH) is a common complication in patients with left ventricular assist devices (LVADs) and carries a dismal prognosis. Limited data are available on the management and outcomes in this population, which are essential to determine an optimal treatment strategy. We conducted a systematic literature review to determine the clinical characteristics and survival of this population. METHODS: PubMed, Ovid, Embase. Scopus, Cochrane, CENTRAL, and Web of Science articles were selected using the following terms: ("Heart-Assist Devices" or "left ventricular assist device" or "LVAD") AND ("intracranial hemorrhage" OR "cerebral hemorrhage" OR "brain hemorrhage" OR "intracerebral hemorrhage" OR "intraparenchymal hemorrhage" OR "hemorrhagic stroke"). Abstracts and articles were screened according to inclusion and exclusion criteria that were determined a priori. Potential studies were reviewed by 4 authors, who reached a consensus on the final studies to be included. RESULTS: The literature review yielded 609 abstracts, which were screened according to predetermined inclusion criteria. A total of 143 full-text articles were reviewed, and 8 articles were included in the final qualitative analysis. These studies reviewed data for 597 patients with LVADs who had ICH. The mortality for ICH was widely variable across studies and ranged from 16% to 100%. CONCLUSIONS: There is minimal existing literature on patients with LVAD with ICH that report patient outcomes in a nonstandardized fashion. The studies included in this analysis report mortality consistent with previous reports, indicating a need for further investigation to identify risk factors and improve outcomes in these patients.
BACKGROUND: Intracranial hemorrhage (ICH) is a common complication in patients with left ventricular assist devices (LVADs) and carries a dismal prognosis. Limited data are available on the management and outcomes in this population, which are essential to determine an optimal treatment strategy. We conducted a systematic literature review to determine the clinical characteristics and survival of this population. METHODS: PubMed, Ovid, Embase. Scopus, Cochrane, CENTRAL, and Web of Science articles were selected using the following terms: ("Heart-Assist Devices" or "left ventricular assist device" or "LVAD") AND ("intracranial hemorrhage" OR "cerebral hemorrhage" OR "brain hemorrhage" OR "intracerebral hemorrhage" OR "intraparenchymal hemorrhage" OR "hemorrhagic stroke"). Abstracts and articles were screened according to inclusion and exclusion criteria that were determined a priori. Potential studies were reviewed by 4 authors, who reached a consensus on the final studies to be included. RESULTS: The literature review yielded 609 abstracts, which were screened according to predetermined inclusion criteria. A total of 143 full-text articles were reviewed, and 8 articles were included in the final qualitative analysis. These studies reviewed data for 597 patients with LVADs who had ICH. The mortality for ICH was widely variable across studies and ranged from 16% to 100%. CONCLUSIONS: There is minimal existing literature on patients with LVAD with ICH that report patient outcomes in a nonstandardized fashion. The studies included in this analysis report mortality consistent with previous reports, indicating a need for further investigation to identify risk factors and improve outcomes in these patients.