Neurological complications associated with left ventricular assist device therapy

ABSTRACT

Introduction: Associated with significant morbidity and mortality, neurological complications in adult patients with left ventricular assist devices (LVAD) approaches a prevalence as high as 25%. As the number of individuals using LVAD support grows, it is increasingly important for providers to understand the hematologic and hemodynamic changes associated with LVAD implantation, the risk factors for neurological complications and their mitigation strategies.

Areas covered: PubMed searches were completed using the terms ‘Left ventricular assist device and stroke’ (994 results) then ‘Left ventricular assist device and stroke risk factors’ (199 results). Results were filtered by ‘humans’ (178 results). The manuscript focuses on the risk factors and mitigation strategies for stroke identified in the literature following LVAD implantation and managing this complication.

Expert commentary: There is little consensus on how to accurately predict stroke risk in the LVAD population. While some recent large-scale clinical trials identified a limited number of risk factors, further research is warranted to generate reliable predictive models and treatment protocols for these patients. This should include developing novel agents and monitoring techniques to individualize anticoagulation therapy while safely balancing the risk of bleeding, thrombosis and stroke. A multi-specialty commitment is necessary to further standardize the management of these patients.

KEYWORDS:

• Left ventricular assist device
• neurologic complications
• ischemic stroke
• hemorrhagic stroke
• heart failure

Declaration of interest

R John receives research grant support from Abbott Medical and Medtronic. All authors are employees of University of Minnesota. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was funded by the University of Minnesota