Stroke Complications in Patients Requiring Durable VAD Systems after VA-ECMO Support

Objectives: Stroke is considered as one of the frequent complications following left ventricular device (VAD) implantation. The aim of this multicenter study was to investigate stroke complications in patients requiring durable VADs following venoarterial membrane oxygenation (VA-ECMO) support.

Methods: Data of 11 high-volume VA-ECMO/VAD centers are collected and evaluated to identify patients who underwent durable mechanical circulatory support system implantation after ECMO support between January 2010 and July 2018. Data of patients who developed postoperative stroke complication were analyzed and compared.

Result: A total of 531 patients met the inclusion criteria. Patients who were supported with pulsatile pumps, CardioWest TAH and DeBakey VADs are excluded from the analysis. The remaining 501 patients (mean age: 53 ± 2 years, 82% male, average VA-ECMO support duration 7 ± 7 days and average MELD score of 19 ± 8) were supported with either HeartWare HVAD, HeartMate II or HeartMate III. A total of 295 patients (59%) were operated on VA-ECMO, and 95 patients (19%) underwent concomitant procedures at the time of VAD implantation. Bleeding requiring resternotomy was documented in 174 (35%) and mechanical RVAD support for RV failure was necessary in 216 (43%) of patients. A total of 142 patients (28%) developed postoperative stroke on device during the follow-up (110 ischemic and 32 hemorrhagic) after a median VAD support of 116 days. Meanwhile, 55 patients (11%) developed pump thrombosis during the follow-up (median follow-up = 520 days, 21% underwent heart transplantation, and in 5% device was explanted after LV recovery). A total of 36 (7%) and 82 (16%) developed stroke during the first 30 days and 1 year, respectively. Up to 42 patients (30%) expired due to stroke. No major differences between preoperative characteristics of the stroke versus no stroke group were observed except for higher rate of IABP in the stroke group (30 vs. 20%). The postoperative complications were comparable between the groups. However, a significantly higher rate of the heart transplantation (25 vs. 11%), lower rate of pump thrombosis (8 vs. 18%) and lower rate of death on device (52 vs. 68%) was documented in non-stroke group.

Conclusion: Stroke complication appears to be a common complication in patients requiring durable VAD support after VA-ECMO. It associates with a higher rate of pump thrombosis and consequent mortality on device.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021