title: Pre-operative and post-operative risk factors associated with neurologic complications in patients with advanced heart failure supported by a left ventricular assist device.
abstract: BACKGROUND
  Neurologic complications (NCs) are the major adverse events after left ventricular assist device (LVAD) surgery. Pre-operative and post-operative factors associated with NCs in patients with LVADs were investigated.
  
  
  METHODS
  We reviewed 307 consecutive patients undergoing LVAD surgery (167 HeartMate I and 140 HeartMate II devices) at Columbia University Medical Center between November 2000 and December 2010. Clinical characteristics and hemodynamic and laboratory indexes were analyzed. NC was defined according to the Interagency Registry for Mechanically Assisted Circulatory Support definition of neurologic dysfunction, including transient ischemic attack (TIA) and ischemic or hemorrhagic cerebrovascular accident (CVA).
  
  
  RESULTS
  NCs developed in 43 patients (14.0%) at 91.8 ± 116.3 days post-operatively. The frequency of NC development was similar in HeartMate I and II patients. Patients with NC showed a higher frequency of pre-LVAD CVA history (27.9% vs 15.5%, p = 0.046), lower pre-operative sodium (129.0 ± 7.0 vs 132.1 ± 8.1 mg/dl, p = 0.018) and albumin concentrations (3.5 ± 0.7 vs 3.7 ± 0.6 mg/dl, p = 0.049), lower post-operative hematocrit (34.9% ± 5.1% vs 37.8% ± 6.1%, p = 0.0034), sodium (131.6 ± 7.7 vs 134.4 ± 6.4 mg/dl, p = 0.010) and albumin concentrations (3.7 ± 0.5 vs 3.9 ± 0.5 mg/dl, p = 0.0016), and higher frequency of post-operative infection (39.5% vs 19.3%, p = 0.003) than those without NC. Multiple regression analysis revealed that CVA history (odds ratio, 2.37, 95% confidence interval, 1.24-5.29; p = 0.011) and post-operative infection (odds ratio, 2.99, 95% confidence interval, 1.16-10.49; p = 0.011) were highly associated with NC development. The combination of CVA history, pre-operative and post-operative sodium and albumin, and post-operative hematocrit and infection could discriminate patients developing NCs with a probability of 76.6%.
  
  
  CONCLUSIONS
  Previous stroke, persistent malnutrition and inflammation, severity of heart failure, and post-LVAD infections are key factors associated with development of NCs after LVAD implantation.
authors: Division of Cardiology, Department of Medicine, Department of Surgery, Columbia University Medical Center, New York, New York, USA. ts2639@columbia.edu
authors: Tomoko S
authors: TS
authors: Kato
authors: P Christian
authors: PC
authors: Schulze
authors: Jonathan
authors: J
authors: Yang
authors: Ernest
authors: E
authors: Chan
authors: Khurram
authors: K
authors: Shahzad
authors: Hiroo
authors: H
authors: Takayama
authors: Nir
authors: N
authors: Uriel
authors: Ulrich
authors: U
authors: Jorde
authors: Maryjane
authors: M
authors: Farr
authors: Yoshifumi
authors: Y
authors: Naka
authors: Donna
authors: D
authors: Mancini
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D057234:Preoperative Period; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology