Harvey Laura, Holley Christopher, Roy Samit S, Eckman Peter, Cogswell Rebecca, Liao Kenneth, John Ranjit
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Ann Thorac Surg. 2015 Aug;100(2):535-41. doi: 10.1016/j.athoracsur.2015.02.094. Epub 2015 Jun 9.
Left ventricular assist devices (LVADs) are increasingly used in patients with heart failure. To study the impact of stroke on clinical outcomes after continuous-flow (CF-) LVAD implantation, we evaluated our single-center experience.
From 2006 to 2013, we implanted the HeartMate II CF-LVAD in 230 patients. We used standard statistical methods to evaluate our results.
Of our study group, 185 patients (80.4%) received the CF-LVAD as a bridge to transplantation. Strokes occurred in a total of 39 patients (17%), an incidence rate of 0.064 strokes per person-year: 19 (48.7%) were embolic, and 20 (51.3%) were hemorrhagic. The stroke-free rate at 6 months after HeartMate II implantation was 92.6%, at 12 months, 89.6%, and at 24 months, 86.1%. Baseline demographic characteristics did not differ significantly, except that stroke patients had a lower incidence of coronary artery disease (p = 0.004) and prior cardiac surgery (p = 0.001). We noted a trend toward an increased risk of stroke in patients with CF-LVAD-related infections (p = 0.053). The survival rate in stroke (versus stroke-free) patients at 6 months was 84.6% (versus 84.2%); at 12 months, 71.8% (versus 81.6%); and at 24 months, 53.9% (versus 74.7%; p = 0.0019). During a median follow-up time of 761 days, mortality risk in stroke patients was 2.01 times that of stroke-free patients (hazard ratio = 2.01; p = 0.004).
Stroke while on CF-LVAD support was associated with significant mortality. To reduce the risk of stroke, it is essential to further elucidate risk factors, to optimize anticoagulation, and to further understand the impact of LVAD-related infections.
左心室辅助装置（LVADs）在心力衰竭患者中的应用越来越广泛。为研究卒中对连续血流（CF-）LVAD植入术后临床结局的影响，我们评估了我们单中心的经验。
2006年至2013年，我们为230例患者植入了HeartMate II CF-LVAD。我们使用标准统计方法评估结果。
在我们的研究组中，185例患者（80.4%）接受CF-LVAD作为移植桥梁。共有39例患者（17%）发生卒中，每人年卒中发生率为0.064次：19例（48.7%）为栓塞性卒中，20例（51.3%）为出血性卒中。HeartMate II植入后6个月的无卒中率为92.6%，12个月时为89.6%，24个月时为86.1%。除卒中患者冠心病发生率较低（p = 0.004）和既往心脏手术发生率较低（p = 0.001）外，基线人口统计学特征无显著差异。我们注意到CF-LVAD相关感染患者卒中风险有增加趋势（p = 0.053）。卒中（与无卒中相比）患者6个月时的生存率为84.6%（与84.2%相比）；12个月时为71.8%（与81.6%相比）；24个月时为53.9%（与74.7%相比；p = 0.0019）。在中位随访时间761天内，卒中患者的死亡风险是无卒中患者的2.01倍（风险比 = 2.01；p = 0.004）。
CF-LVAD支持期间发生的卒中与显著的死亡率相关。为降低卒中风险，进一步阐明危险因素、优化抗凝以及进一步了解LVAD相关感染的影响至关重要。
