Journal article
Early Stroke Following Durable Left Ventricular Assist Device (LVAD) Implantation: An Analysis of The Society of Thoracic Surgeons Intermacs National Database
The Journal of heart and lung transplantation, v 44(2)
08 Oct 2024
PMID: 39389330
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Stroke remains a devastating complication of durable left ventricular assist device (LVAD) therapy. This study evaluated the incidence and risk factors for early stroke within 7 days following LVAD implantation investigating both traditional pre-implant and new intraoperative variables collected by The Society of Thoracic Surgeons (STS) Intermacs National Database.
STS Intermacs was queried for patients undergoing implantation of a fully magnetically levitated centrifugal LVAD between 11/25/2020 and 6/30/2023. STS Intermacs stroke definitions were used to identify patients who suffered a stroke within the first 7 postoperative days (POD). A multivariable logistic regression model was created to generate adjusted odd ratios (OR) for variables associated with early stroke.
Among 6950 patients in the study cohort, 5.9% (413/6950) developed a stroke after a median follow-up of 11 months, with 50% (205/413) of strokes occurring within 7 days after LVAD implantation. Of the strokes occurring during POD 0-7, 70% (144/205) occurred on POD 0-2. By multivariable analysis, the following factors were associated with early stroke: older age (70 vs. 50; OR 1.4, P=0.0129), white race (OR 1.5, P=0.0078), pre-implant temporary MCS bridge (temporary LVAD only: OR 1.6, ECMO only: OR 1.7, combination of both devices: OR 3.3; P=0.0001) and presence of an unremoved left atrial clot (OR 8.0, P<0.0001).
A significant proportion of strokes occur within the first 7 days following LVAD implantation, particularly within the first 2 days. In addition to pre-implant variables, we identified modifiable intraoperative factors associated with stroke that provide an opportunity for further risk mitigation and improvement in quality of care.
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2 citations in Scopus
Details
- Title
- Early Stroke Following Durable Left Ventricular Assist Device (LVAD) Implantation: An Analysis of The Society of Thoracic Surgeons Intermacs National Database
- Creators
- Ezequiel J Molina - Piedmont Atlanta HospitalDaniel Goldstein - Albert Einstein College of MedicineRyan S. Cantor - Kirklin ClinicManreet K Kanwar - Allegheny Health NetworkDan Meyer - Baylor University Medical CenterUlrich Jorde - Montefiore Medical CenterOmar Saeed - Albert Einstein College of MedicineKatherine Wood - University of Rochester Medical CenterRama Raju Rudraraju - Kirklin Solutions, Hoover, ALSeth Lewis - Kirklin ClinicJames K. Kirklin - Kirklin ClinicFrancis D. Pagani - University of Michigan–Ann ArborArman Kilic - Medical University of South Carolina
- Publication Details
- The Journal of heart and lung transplantation, v 44(2)
- Publisher
- Elsevier; NEW YORK
- Number of pages
- 10
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001417715200001
- Scopus ID
- 2-s2.0-85208189855
- Other Identifier
- 991021932102204721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery
- Transplantation