title: Stroke After Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) are increasingly used in patients with heart failure. To study the impact of stroke on clinical outcomes after continuous-flow (CF-) LVAD implantation, we evaluated our single-center experience.
  
  
  METHODS
  From 2006 to 2013, we implanted the HeartMate II CF-LVAD in 230 patients. We used standard statistical methods to evaluate our results.
  
  
  RESULTS
  Of our study group, 185 patients (80.4%) received the CF-LVAD as a bridge to transplantation. Strokes occurred in a total of 39 patients (17%), an incidence rate of 0.064 strokes per person-year: 19 (48.7%) were embolic, and 20 (51.3%) were hemorrhagic. The stroke-free rate at 6 months after HeartMate II implantation was 92.6%, at 12 months, 89.6%, and at 24 months, 86.1%. Baseline demographic characteristics did not differ significantly, except that stroke patients had a lower incidence of coronary artery disease (p = 0.004) and prior cardiac surgery (p = 0.001). We noted a trend toward an increased risk of stroke in patients with CF-LVAD-related infections (p = 0.053). The survival rate in stroke (versus stroke-free) patients at 6 months was 84.6% (versus 84.2%); at 12 months, 71.8% (versus 81.6%); and at 24 months, 53.9% (versus 74.7%; p = 0.0019). During a median follow-up time of 761 days, mortality risk in stroke patients was 2.01 times that of stroke-free patients (hazard ratio = 2.01; p = 0.004).
  
  
  CONCLUSIONS
  Stroke while on CF-LVAD support was associated with significant mortality. To reduce the risk of stroke, it is essential to further elucidate risk factors, to optimize anticoagulation, and to further understand the impact of LVAD-related infections.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Laura
authors.initials: L
authors.lastname: Harvey
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Christopher
authors.initials: C
authors.lastname: Holley
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Samit S
authors.initials: SS
authors.lastname: Roy
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Peter
authors.initials: P
authors.lastname: Eckman
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cogswell
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Liao
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: johnx008@umn.edu.
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
mesh_terms: D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods