Perioperative Stroke Following Implantation of Left Ventricular Assist Device: A Retrospective Cohort Study

Objectives: Stroke is common following left ventricular assist device (LVAD) implantation, although comprehensive data on perioperative strokes in this uncommon population is lacking. The current study aim was to characterize the presentation, features, and outcomes of perioperative cerebrovascular ischemia post-LVAD implantation at the authors' institution.

Design: Single-center retrospective cohort.

Setting: St. Paul's Hospital, Vancouver, British Columbia, Canada.

Participants: Adult patients who received an LVAD between January 1, 2008, and August 31, 2021, were included, and those who died intraoperatively or underwent a concurrent cardiac surgical procedure were excluded.

Interventions: Data on demographics, comorbidities, stroke risk factors and characteristics, management, and outcomes (transplant, explant, death with LVAD in situ) were extracted.

Measurements and main results: After exclusions, 172 adult patients who underwent LVAD implantation during the study period were included and analyzed. The rate of perioperative stroke was 12.8% (22/172). Of these, 72.7% (16/22) had a stroke occur within 7 days of surgery, and 86.4% (19/22) had a primarily ischemic (v hemorrhagic) event. A total of 68.2% (15/22) were intubated, sedated, or recently extubated at symptom onset, complicating diagnosis. All were managed supportively or palliated without specific stroke intervention. Patients who experienced a perioperative stroke had a significantly lower cumulative incidence of survival to cardiac transplantation and a significantly higher cumulative incidence of dying with their device in situ.

Conclusions: LVAD patients carry a high risk of perioperative stroke. They experience delayed recognition and diagnosis, limited intervention, and poor outcomes. Frequent neurological assessment and a low threshold for neuroimaging are prudent.