Abstract
INTRODUCTION
Intracranial hemorrhage (ICH) is one of the most dangerous events in patients with a left ventricular assist device (LVAD) and poses a significant management challenge for neurosurgeons. These patients require anticoagulation to prevent pump thrombosis; however, the occurrence of ICH mandates stoppage of anticoagulation to prevent further hemorrhage. Given this management challenge, our aim was to assess outcomes in LVAD patients who suffered an ICH.
METHODS
A retrospective review of a large volume LVAD center over a 2-yr period (January 2017-January 2019) was performed. LVAD patients with ICH requiring a neurosurgical consultation were identified. Hemorrhage type along with interventions and patient outcomes were recorded.
RESULTS
We identified 27 LVAD patients with ICH that received a neurosurgical consultation. The average INR at the time of ICH was 2.7 (1.0-8.8). Hemorrhage types seen were lobar (10/27, 37%), subarachnoid hemorrhage (SAH) (5/27, 19%), SDH (4/27, 15%), cerebellar ICH (3/27, 11%), multiple ICH (3/27, 11%), and hemorrhagic conversion (2/27, 7%). The overall mortality rate was 48.2% (13/27), with the highest mortality being in those patients who had multiple ICH at the time of presentation (3/3, 100%). The majority of patients with ICH (85.2%) were nonoperative. Lobar IPH was >3 cm in 80% (8/10) of these, and 6/8 (75%) ultimately died. In total, 11% (3/27) received surgical intervention. Of these, 67% ultimately withdrew care. In total, 77% (10/13) of patients died as a result of the ICH. In total, 80% of patients with SAH were ultimately discharged home.
CONCLUSION
Patients with an LVAD and lobar IPH >3 cm or multiple ICH had a universally poor prognosis despite any intervention. ICH type and size in LVAD patients may predict patient outcomes and could be used to triage operative vs nonoperative candidates.
Neurosurgical Management in Left Ventricular Assist Device (LVAD) Patients With Intracerebral Hemorrhage (ICH)
