Intracranial Hemorrhage in Patients with a Left Ventricular Assist Device

The gold standard treatment for end-stage heart failure is heart transplantation; however, the rate of transplantation remains inadequate because of the paucity of organ donation. The left ventricular assist device (LVAD) has been used as a bridge therapy before transplantation. The LVAD is being used increasingly because it reduces mortality despite the accompanying morbidities. Therefore, the anesthetic management of LVAD-related morbidities is important and requires experience and knowledge. Herein, we describe a 60-year-old male patient with an LVAD with complaints of right hemiparesis, dysphasia, and facial paralysis. We aim to present the anesthetic management of a patient with intracranial hemorrhage who underwent LVAD exchange due to thrombosis.

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Abstract WMP66: Infection and Coagulopathy in Left Ventricular Assist Device (LVAD)-Associated Intracranial Hemorrhage: A Case-Crossover Study

Stroke ◽

10.1161/str.49.suppl_1.wmp66 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Sung-Min Cho ◽

Tiffany Lee ◽

Randall Starling ◽

Ken Uchino

Keyword(s):

Crossover Study ◽

Intracranial Hemorrhage ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Case Crossover ◽

Left Ventricular Assist

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Abstract 13573: Trends, Predictors and Outcomes of Intracranial Hemorrhage in Patients With Left Ventricular Assist Device

Circulation ◽

10.1161/circ.132.suppl_3.13573 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Muhammad Shahreyar ◽

Sanjay Bhandari ◽

Mobin Malik ◽

Vijayadershan Muppidi ◽

Geetanjali Dang ◽

...

Keyword(s):

Heart Failure ◽

Intracranial Hemorrhage ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Discharge Diagnosis ◽

Assist Device ◽

Ventricular Assist ◽

Comorbidity Burden ◽

Left Ventricular Assist

Introduction: Left ventricular assist device (LVAD) is being increasingly utilized in patients with advanced heart failure both as bridge to heart transplantation and as destination therapy. Intracranial hemorrhage (ICH) is one of major complications associated with LVAD. However, current trends on utilization of LVAD and associated ICH in real world practice are not known. Methods: We analyzed patients in the Nationwide Inpatient Sample (NIS) between 2007 and 2011. Heart failure patients with LVAD were identified from the database and patients with discharge diagnosis of ICH were compared to those without ICH. Trends and outcomes of ICH in patients with LVAD were analyzed. In addition, predictors of ICH were identified using a multivariate regression model. Results: We identified 20,443 discharges with a primary diagnosis of heart failure with LVAD of which 447 patients had a co-diagnosis of ICH. We saw a significant increase in discharge diagnosis of heart failure with LVAD from 1232 discharges in 2007 to 6308 in 2011 (p&lt0.001)(Figure). However, the incidence of ICH in this patient population decreased from 3.9% in 2007 to 2.4% in 2011. On multivariate analysis, in-hospital mortality was significantly higher in the ICH group (OR: 9.5, P=0.0001). After adjustment for potential confounders age &lt35 years (OR: 2.4, P=0.01) and a rising Charlson co-morbidity index score were independent predictors of ICH whereas presence of diabetes (OR: 0.05, P=0.001), chronic lung disease (OR:0.07, P=0.001), renal disease (OR: 0.09, P=0.001) and peripheral vascular disease (OR: 0.12, P=0.002) were found to be protective of ICH. Conclusions: Our analysis indicates an increasing trend in utilization of LVAD but a decrease in incidence of ICH over the same period. ICH was found to increase risk of mortality by nearly 10 fold. Increasing comorbidity burden increases the risk of ICH whereas age and certain individual co-morbidities appear to have a paradoxical effect on risk of ICH.

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