Asymmetric pattern of cerebrovascular lesions in patients after left ventricular assist device implantation.
OBJECTIVE
Stroke is a major adverse event after left ventricular assist device (LVAD) surgery. The purpose of this study was to describe differences in hemispheric distribution of stroke in LVAD patients.


METHODS
We reviewed 317 consecutive patients who underwent LVAD surgery between November 2000 and July 2011. Stroke during LVAD support was analyzed.


RESULTS
In total, 46 strokes occurred at 76.0±96.8 days postoperatively. Among the 46 strokes, 27 events (58.7%) occurred in right hemisphere, 13 events (28.2%) in the left hemisphere, 3 events (8.7%) occurred bilaterally, and 2 events (4.3%) were vertebrobasilar lesions. The right hemispheric stroke was significantly more common in patients with postoperative infection compared with left hemispheric events.


CONCLUSIONS
Stroke after LVAD implantation has a right hemispheric predominance. This finding suggests LVAD-related thrombus in the setting of infection and/or the anatomic configuration of LVAD outflow cannula-ascending aorta anastomosis to be highly associated with stroke after LVAD surgery.
Columbia University Medical Center, Department of Medicine, Division of Cardiology, 622 West 168th St, New York, NY 10032, USA.
Tomoko S
TS
Kato
Takeyoshi
T
Ota
P Christian
PC
Schulze
Maryjane
M
Farr
Ulrich
U
Jorde
Hiroo
H
Takayama
Yoshifumi
Y
Naka
Toru
T
Yamashita
Donna M
DM
Mancini
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001011:Aorta / Q000503:physiopathology; D001488:Basilar Artery / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000150:complications; D020767:Intracranial Thrombosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology; D014711:Vertebral Artery / Q000473:pathology
D000925:Anticoagulants