Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL Artificial organs Pub Date : 2024-05-27 DOI:10.1111/aor.14775

Guglielmo Gallone, Daniel Lewin, Sebastian Rojas Hernandez, Alexander Bernhardt, Michael Billion, Anna Meyer, Ivan Netuka, J-J Kooij, Marina Pieri, Mariusz K. Szymanski, Christian H. Moeller, Payam Akhyari, Khalil Jawad, Ihor Krasivskyi, Bastian Schmack, Gloria Färber, Marta Medina, Assad Haneya, Daniel Zimpfer, Gaik Nersesian, Pia Lanmueller, Antonio Spitaleri, Mehmet Oezkur, Ilija Djordjevic, Diyar Saeed, Massimo Boffini, Julia Stein, F. Gustafsson, Anna Mara Scandroglio, Gaetano Maria De Ferrari, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Mauro Rinaldi, Evgenij V. Potapov, Antonio Loforte

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Abstract

Background

Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled.

Methods

Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied.

Results

Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48–65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4–22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3–85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4–18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9–4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49–7.88, p = 0.004) stroke were associated with increased 1-year mortality.

Conclusions

Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.

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微轴流泵桥接患者植入持久性左心室辅助装置后的卒中预后：大型登记册的启示。

背景：植入持久性左心室辅助装置（d-LVAD）后发生卒中预示着高死亡率。缺血性和出血性卒中的发生率以及临时机械循环支持（tMCS）管理对需要桥接至使用微轴流泵（mAFP，Abiomed）的 d-LVAD 患者的卒中预后的影响尚未确定：方法：回顾性纳入了在 19 家医疗机构使用 mAFP 桥接后接受 d-LVAD 植入术的连续患者。方法：回顾性纳入了在 19 家机构接受 mAFP 桥接后植入 d-LVAD 的连续患者：在 341 名接受 mAFP 植入术后接受 d-LVAD 植入术的患者中（男性占 83.6%，年龄 58 [48-65] 岁，mAFP 5.0/5.5 72.4%），早期缺血性卒中发生率为 10.8%，早期出血性卒中发生率为 2.9%。tMCS特征（mAFP设备和接入类型、支持持续时间、从主动脉内球囊泵升级、ECMELLA、植入d-LVAD时的ECMELLA、溶血和出血）与植入d-LVAD后的缺血性卒中无关。相反，设备型号（mAFP 2.5/CP vs. mAFP 5.0/5.5：HR 5.6，95%CI 1.4-22.7，p = 0.015）、mAFP 支持下的溶血（HR 10.5，95%CI 1.3-85.3，p = 0.028）和 d-LVAD 植入时的 ECMELLA（HR 5.0，95% CI 1.4-18.7，p = 0.016）与 d-LVAD 植入后出血性卒中风险增加有关。早期缺血性中风（HR 2.7，95% CI 1.9-4.5，p = 0.016）和出血性中风（HR 2.7，95% CI 1.9-4.5，p = 0.016）的风险都与植入 d-LVAD 后出血性中风风险增加有关：在接受 d-LVAD 植入术并获得 mAFP 支持的患者中，tMCS 的特征不会影响缺血性卒中的发生，而有几个因素与出血性卒中相关，这表明需要采取积极的治疗措施来减少这种并发症。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.

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