Tsukui Hiroyuki, Abla Adib, Teuteberg Jeffrey J, McNamara Dennis M, Mathier Michael A, Cadaret Linda M, Kormos Robert L
Division of Cardiothoracic Surgery, Heart, Lung, and Esophageal Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):114-23. doi: 10.1016/j.jtcvs.2007.02.044. Epub 2007 Jun 4.
A cerebrovascular accident is a devastating adverse event in a patient with a ventricular assist device. The goal was to clarify the risk factors for cerebrovascular accident.
Prospectively collected data, including medical history, ventricular assist device type, white blood cell count, thrombelastogram, and infection, were reviewed retrospectively in 124 patients.
Thirty-one patients (25%) had 48 cerebrovascular accidents. The mean ventricular assist device support period was 228 and 89 days in patients with and without cerebrovascular accidents, respectively (P < .0001). Sixty-six percent of cerebrovascular accidents occurred within 4 months after implantation. Actuarial freedom from cerebrovascular accident at 6 months was 75%, 64%, 63%, and 33% with the HeartMate device (Thoratec Corp, Pleasanton, Calif), Thoratec biventricular ventricular assist device (Thoratec Corp), Thoratec left ventricular assist device (Thoratec), and Novacor device (WorldHeart, Oakland, Calif), respectively. Twenty cerebrovascular accidents (42%) occurred in patients with infections. The mean white blood cell count at the cerebrovascular accident was greater than the normal range in patients with infection (12,900/mm3) and without infection (9500/mm3). The mean maximum amplitude of the thrombelastogram in the presence of infection (63.6 mm) was higher than that in the absence of infection (60.7 mm) (P = .0309).
The risk of cerebrovascular accident increases with a longer ventricular assist device support period. Infection may activate platelet function and predispose the patient to a cerebrovascular accident. An elevation of the white blood cell count may also exacerbate the risk of cerebrovascular accident even in patients without infection. Selection of device type, prevention of infection, and meticulous control of anticoagulation are key to preventing cerebrovascular accident.
脑血管意外是心室辅助装置患者发生的灾难性不良事件。目标是明确脑血管意外的危险因素。
对前瞻性收集的数据进行回顾性分析，这些数据包括124例患者的病史、心室辅助装置类型、白细胞计数、血栓弹力图及感染情况。
31例患者（25%）发生了48次脑血管意外。发生和未发生脑血管意外的患者，心室辅助装置的平均支持时间分别为228天和89天（P <.0001）。66%的脑血管意外发生在植入后4个月内。使用HeartMate装置（Thoratec公司，加利福尼亚州普莱森顿）、Thoratec双心室心室辅助装置（Thoratec公司）、Thoratec左心室辅助装置（Thoratec）和Novacor装置（世界心脏公司，加利福尼亚州奥克兰）的患者，6个月时无脑血管意外的精算自由度分别为75%、64%、63%和33%。20次脑血管意外（42%）发生在感染患者中。发生脑血管意外时，感染患者（12,900/mm³）和未感染患者（9500/mm³）的平均白细胞计数均高于正常范围。感染患者血栓弹力图的平均最大振幅（63.6 mm）高于未感染患者（60.7 mm）（P = 0.0309）。
脑血管意外的风险随心室辅助装置支持时间的延长而增加。感染可能激活血小板功能，使患者易发生脑血管意外。即使在未感染的患者中，白细胞计数升高也可能增加脑血管意外的风险。选择装置类型、预防感染及严格控制抗凝是预防脑血管意外的关键。
