Outcomes after stroke complicating left ventricular assist device.
Outcomes after stroke complicating left ventricular assist device.
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DOI：
10.1016/j.healun.2016.03.014
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Colombo PC
中科院分区：
文献类型：
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作者：
Willey JZ;Gavalas MV;Trinh PN;Yuzefpolskaya M;Reshad Garan A;Levin AP;Takeda K;Takayama H;Fried J;Naka Y;Topkara VK;Colombo PC
卒中是持续血流左心室辅助装置（CF-LVAD）支持期间的主要并发症之一。风险因素已被很好地描述，尽管对治疗和结果知之甚少。我们对CF-LVAD患者的脑卒中亚型和严重程度的脑卒中结局和移植资格进行了大型单中心研究。在2008年1月1日至2015年4月1日期间，301例患者接受了CF-LVAD（266例HeartMate II （HM II）和35例HeartWare (HVAD)）。卒中被定义为局灶性神经功能缺损伴神经影像学异常。脑出血（ICH）的定义排除了硬膜下血肿和缺血性中风（IS）的出血转化。IS的治疗包括适当的动脉内栓塞切除术（IAE）；脑出血的治疗包括凝血功能的逆转。卒中严重程度采用美国国立卫生研究院卒中量表（NIHSS）进行测量。结果是住院死亡率和移植状态。40例患者发生中风：8例脑出血（4例HM II， 4例HVAD）， 32例IS（26例HM II， 6例HVAD）。8例脑出血患者中有4例死亡（50%）（NIHSS 18.8±13.7 vs 1.8±1.7,p=0.049）。32例IS中12例发生出血转化，5例经IAE治疗。9例死亡（28%）（NIHSS 16.2±10.8 vs 7.0±7.6,p=0.011）。32例IS患者中，12例已接受移植，1例正在等待移植；无脑出血患者移植。卒中后住院死亡率受初始神经损伤的显著影响。IS患者似乎从住院治疗中获益最多，并且通常能够充分恢复，从而能够进行移植。
Stroke is one of the leading complications during continuous flow-left ventricular assist device (CF-LVAD) support. Risk factors have been well described, though less is known regarding treatment and outcomes. We present a large single center experience on stroke outcome and transplant eligibility by stroke subtype and severity in CF-LVAD patients. 301 patients underwent CF-LVAD (266 HeartMate II (HM II) and 35 HeartWare (HVAD)) between 1/1/2008 and 4/1/2015. Stroke was defined as a focal neurological deficit with abnormal neuroimaging. Intracerebral hemorrhage (ICH) definition excluded subdural hematoma and hemorrhagic conversion of an ischemic stroke (IS). Treatment in IS included intra-arterial embolectomy (IAE) when appropriate; treatment in ICH included reversal of coagulopathy. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). Outcomes were in-hospital mortality and transplant status. 40 patients suffered a stroke: 8 ICH (4 HM II, 4 HVAD) and 32 IS (26 HM II, 6 HVAD). Among 8 ICH there were 4 deaths (50%) (NIHSS 18.8±13.7 vs 1.8±1.7 in survivors, p=0.049). Among 32 IS, 12 had hemorrhagic conversion and 5 were treated with IAE. There were 9 deaths (28%) (NIHSS 16.2±10.8 vs 7.0±7.6 in survivors, p=0.011). Among the 32 IS patients, 12 underwent transplant and 1 is awaiting transplant; no ICH patients were transplanted. In-hospital mortality after stroke is significantly affected by the initial neurological impairment. Patients with IS appear to benefit the most from in-hospital treatment and often make sufficient recovery to be able to progress to transplant.