title: The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure.
abstract: OBJECTIVE
  Cerebral hyperperfusion is a life-threatening syndrome that can occur in patients with chronically hypoperfused cerebral vasculature whose normal cerebral circulation was re-established after carotid endarterectomy or angioplasty. We sought to determine whether the abrupt restoration of perfusion to the brain after left ventricular assist device (LVAD) implantation produced similar syndromes.
  
  
  METHODS
  We studied the role of increased systemic flow after LVAD implantation on neurologic dysfunction in 69 consecutive HeartMate XVE LVAD (Thoratec, Pleasanton, Calif) recipients from October 2001 through June 2006. Neurologic dysfunction was defined as postoperative permanent or transient central change in neurologic status, including confusion, focal neurologic deficits, visual changes, seizures, or coma for more than 24 hours within 30 days after LVAD implantation.
  
  
  RESULTS
  We found that 19 (27.5%) patients had neurologic dysfunction, including encephalopathy (n = 11), coma (n = 3), and other complications (n = 5). The multivariate analysis showed that an increase in cardiac index from the preoperative baseline value (relative risk, 1.33 per 25% cardiac index increase; P = .01) and a previous coronary bypass operation (relative risk, 4.53; P = .02) were the only independent predictors of neurologic dysfunction. Reduction of left ventricular assist device flow in 16 of the 19 symptomatic patients led to improvement of symptoms in 14 (87%) patients.
  
  
  CONCLUSIONS
  Our findings showed that normal flow might overwhelm cerebral autoregulation in patients with severe heart failure, suggesting that cerebral hyperperfusion is possible in recipients of mechanical circulatory support with neurologic dysfunction.
authors.affiliation: Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY 10032, USA. KL2384@columbia.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Lietz
authors.forename: Kevin
authors.initials: K
authors.lastname: Brown
authors.forename: Syed S
authors.initials: SS
authors.lastname: Ali
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin-Adams
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boyle
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: Alan D
authors.initials: AD
authors.lastname: Weinberg
authors.forename: Leslie W
authors.initials: LW
authors.lastname: Miller
authors.forename: Soon
authors.initials: S
authors.lastname: Park
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Lazar