Background: The development of stroke while on continuous flow left ventricular assist device (CF-LVAD) remains a source of significant morbidity and mortality. The ability to risk stratify these patients can improve postoperative management.
Objective: To describe the overall experience of cerebrovascular accidents in CF-LVAD patients at a large volume tertiary center and compare the utility of CHADS2, CHA2DS2-VASc, and R2CHADS2 scores.
Methods: A retrospective analysis of 522 patients (524 CF-LVADs: HeartMate-II=402; Heartware=122), between 2003 and 2016, was conducted. Post-operative heparin for 2-3 days, warfarin (goal INR 2-3), and 80-325mg aspirin were administered daily. Cerebrovascular vascular accident (CVA) was defined as any focal or global deficit with positive imaging. The CHADS2, R2CHADS2 and CHA2DS2-VASc scores were calculated. Baseline characteristics and risk assessment scores were compared between patients with ischemic CVA (ICVA) and no CVA (nCVA). Kaplan-Meier analysis was conducted.
Results: Mean age was 54.7±13.6 years, 21.8% were female and 44.8% had ischemic cardiomyopathy. Eighty patients (15.3%) had 98 events of ICVA. Median duration between implant and ICVA was 127 [range 1-2226] days. Hemorrhagic conversion occurred in 9 (9.2%) patients. The CHADS2 (ICVA=2.4±1.0, nCVA=2.3±1.1, p-value=0.53), CHA2DS2-VASc (ICVA=3.2±1.3, nCVA=2.9±1.3, p-value=0.08) and R2CHADS2 (ICVA=3.5±1.5, nCVA=3.2±1.6, p-value=0.22) were all higher for ICVA cohort. Patients with multiple ICVAs had a mean CHADS2 score of 2.5±0.74, CHA2DS2-VASc score of 3.5±1.1, and R2CHADS2 score of 4±1.2. Freedom from stroke was significantly lower in the CHA2DS2-VASc ≥3 compared to the CHA2DS2-VASc <3 [Figure: Kaplan-Meier log-rank p-value=0.009].
Conclusion: CHA2DS2-VASc of ≥3 was associated with ICVA in this cohort of CF-LVAD patients. Specifically tailored risk-scores are needed to better predict those at risk for neurological events in CF-LVADs