title: Outcomes after stroke complicating left ventricular assist device.
abstract: Stroke is one of the leading complications during continuous flow-left ventricular assist device (CF-LVAD) support. Risk factors have been well described, although less is known regarding treatment and outcomes. We present a large single-center experience on stroke outcome and transplant eligibility by stroke sub-type and severity in CF-LVAD patients.
  
  
  
  Between January 1, 2008, and April 1, 2015, 301 patients underwent CF-LVAD (266 HeartMate II [HM I], Thoratec Corp, Pleasanton, CA; 35 HeartWare [HVAD], HeartWare International Inc, Framingham, MA). Stroke was defined as a focal neurologic deficit with abnormal neuroimaging. Intracerebral hemorrhage (ICH) definition excluded sub-dural hematoma and hemorrhagic conversion of an ischemic stroke (IS). Treatment in IS included intra-arterial embolectomy when appropriate; treatment in ICH included reversal of coagulopathy. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). Outcomes were in-hospital mortality and transplant status.
  
  
  
  Stroke occurred in 40 patients: 8 ICH (4 HM II, 4 HVAD) and 32 IS (26 HM II, 6 HVAD). Among 8 ICH patients, there were 4 deaths (50%), with NIHSS of 18.8 ± 13.7 vs 1.8 ± 1.7 in survivors (p = 0.049). Among 32 IS patients, 12 had hemorrhagic conversion and 5 were treated with intra-arterial embolectomy. There were 9 deaths (28%), with NIHSS of 16.2 ± 10.8 vs 7.0 ± 7.6 in survivors (p = 0.011). Among the 32 IS patients, 12 underwent transplant, and 1 is awaiting transplant. No ICH patients received a transplant.
  
  
  
  In-hospital mortality after stroke is significantly affected by the initial neurologic impairment. Patients with IS appear to benefit the most from in-hospital treatment and often make sufficient recovery to be able to progress to transplant.
authors.affiliation: Departments of Neurology. Electronic address: jzw2@columbia.edu.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
authors.affiliation: Medicine.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Gavalas
authors.affiliation: Epidemiology.
authors.forename: Pauline N
authors.initials: PN
authors.lastname: Trinh
authors.affiliation: Medicine.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Medicine.
authors.forename: A
authors.initials: A
authors.lastname: Reshad Garan
authors.affiliation: Medicine.
authors.forename: Allison P
authors.initials: AP
authors.lastname: Levin
authors.affiliation: Surgery, Columbia University, New York, New York.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Surgery, Columbia University, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Medicine.
authors.forename: Justin
authors.initials: J
authors.lastname: Fried
authors.affiliation: Surgery, Columbia University, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Medicine.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: Medicine.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
mesh_terms: D002545:Brain Ischemia; D006333:Heart Failure; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D012189:Retrospective Studies; D020521:Stroke; D016896:Treatment Outcome
keywords: continuous flow; intracerebral hemorrhage; ischemic stroke; left ventricular assist device; stroke; transplant eligibility