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Abstract Details

Stroke Rates in Centrifugal Flow Left Ventricular Assist Devices: A Device-Specific Comparative Analysis
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)

Ischemic and hemorrhagic strokes have been a leading cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. A comparison of stroke rates between centrifugal devices has not been studied.

We aimed to compare the stroke rates between HeartWare (HVAD) and HeartMate 3 (HM3).

We reviewed consecutive patients with acute ischemic stroke or hemorrhagic stroke in a prospectively collected data of patients implanted with centrifugal continuous flow LVADs (HVAD and HM3) from October 2004 to June 2019. Ischemic stroke was determined by persistent neurologic deficits of greater than 24 hours.  Hemorrhagic stroke included intracerebral hemorrhage, subarachnoid hemorrhage, and non-traumatic subdural hematoma. Disabling stroke was defined as permanent neurologic deficits that did not return to pre-stroke baseline by discharge.

Of 305 persons with centrifugal LVADs (176 HVADs; 129 HM3), 56 (18%) developed a stroke event during LVAD support. Age (58 [IQR 51 - 64] HVAD vs. 62 [IQR 61 - 70] HM3) and male sex (34 [87%] HVAD vs 11 [69%] HM3) were similar between the two groups. The median time from implantation to stroke event was 172 days (IQR 48 – 221) in HVAD vs. 36 days (IQR 31 -225) in HM3. Of 176 patients with HVAD, 39 (22%) developed strokes, which was significantly higher than the HM3 group with 17 (13%) strokes (p=0.05). Ischemic stroke rates between devices were similar with 25 (13%) in HVAD and 11 (8.5%) in HM3 (p=0.15). There were 14 (8%) hemorrhagic strokes in HVAD compared to 6 (3%) in HM3 (p=0.34). There were similar disabling strokes between both devices (p= 0.32). The median mortality for LVAD-associated ischemic stroke was 3% while hemorrhagic stroke was 75%.

Total stroke events were more common in HVAD in comparison to HM3. Newer generation centrifugal pump design may contribute to a reduction in total stroke events.

Catherine Hassett, MD
Dr. Hassett has nothing to disclose.
Sung Min Cho, DO (Johns Hopkins Hospital) Dr. Cho has nothing to disclose.
Tracey Huijun Fan, DO Dr. Fan has nothing to disclose.
Ibrahim Migdady, MD Dr. Migdady has nothing to disclose.
Randall Starling Randall Starling has nothing to disclose.
Ken Uchino, MD (Cleveland Clinic Foundation) Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.