Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support

Masashi Kawabori, Ryan T. Conyer, Chitaru Kurihara, Tadahisa Sugiura, Andrew B. Civitello, O. H. Frazier, Jeffrey A. Morgan

Research output: Contribution to journalArticle

Abstract

Background: During continuous-flow left ventricular assist device (CF-LVAD) support, neurologic dysfunction (ND) is a common complication and can be fatal. Few reports provide detailed data on neurologic mortality in such patients. Therefore, we examined ND-related mortality during CF-LVAD support. Methods: Between November 2003 and March 2016, 526 patients underwent implantation of a CF-LVAD (403 HeartMate II [Thoratec, Pleasanton, CA] and 123 HVAD [HeartWare International, Framingham, MA]) at our center. We categorized ND as hemorrhagic or ischemic and recorded resulting deaths. Records were reviewed to determine preoperative demographics, perioperative variables, prevalence and causes of postimplantation ND, duration of support until ND, time from ND to death, laboratory data and medications at the time of ND, post-ND treatment procedures, and causes of hemorrhagic ND. We also performed Cox multivariable logistic regression analysis to identify predictors of ND-related mortality by calculating odds ratios and confidence intervals. Results: Neurologic dysfunction occurred in 141 patients (26.8%), 48 (9.1%) of whom subsequently died. Median duration of left ventricular assist device support before ND was 230 days (range, 3 to 2,422), and median time from ND to death was 3.5 days (range, 0 to 55). Parenchymal hemorrhage was the most frequent cause of early conversion (76.7%). In the Cox multivariable regression analysis, predictors of fatal ND were age, ischemic cause of heart failure, history of stroke, and longer intraoperative aortic cross-clamp time. Conclusions: Our study elucidates the characteristics and risk factors of patients who died of ND during CF-LVAD support. Further studies are required to find ways to decrease the incidence of fatal ND during CF-LVAD support.

Original languageEnglish (US)
Pages (from-to)1132-1138
Number of pages7
JournalAnnals of Thoracic Surgery
Volume107
Issue number4
DOIs
StatePublished - Apr 2019
Externally publishedYes

Fingerprint

Heart-Assist Devices
Neurologic Manifestations
Mortality
Regression Analysis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kawabori, M., Conyer, R. T., Kurihara, C., Sugiura, T., Civitello, A. B., Frazier, O. H., & Morgan, J. A. (2019). Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support. Annals of Thoracic Surgery, 107(4), 1132-1138. https://doi.org/10.1016/j.athoracsur.2018.10.012

Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support. / Kawabori, Masashi; Conyer, Ryan T.; Kurihara, Chitaru; Sugiura, Tadahisa; Civitello, Andrew B.; Frazier, O. H.; Morgan, Jeffrey A.

In: Annals of Thoracic Surgery, Vol. 107, No. 4, 04.2019, p. 1132-1138.

Research output: Contribution to journalArticle

Kawabori, M, Conyer, RT, Kurihara, C, Sugiura, T, Civitello, AB, Frazier, OH & Morgan, JA 2019, 'Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support', Annals of Thoracic Surgery, vol. 107, no. 4, pp. 1132-1138. https://doi.org/10.1016/j.athoracsur.2018.10.012
Kawabori, Masashi ; Conyer, Ryan T. ; Kurihara, Chitaru ; Sugiura, Tadahisa ; Civitello, Andrew B. ; Frazier, O. H. ; Morgan, Jeffrey A. / Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support. In: Annals of Thoracic Surgery. 2019 ; Vol. 107, No. 4. pp. 1132-1138.
@article{274d22033e18443db6029248bd69d7b4,
title = "Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support",
abstract = "Background: During continuous-flow left ventricular assist device (CF-LVAD) support, neurologic dysfunction (ND) is a common complication and can be fatal. Few reports provide detailed data on neurologic mortality in such patients. Therefore, we examined ND-related mortality during CF-LVAD support. Methods: Between November 2003 and March 2016, 526 patients underwent implantation of a CF-LVAD (403 HeartMate II [Thoratec, Pleasanton, CA] and 123 HVAD [HeartWare International, Framingham, MA]) at our center. We categorized ND as hemorrhagic or ischemic and recorded resulting deaths. Records were reviewed to determine preoperative demographics, perioperative variables, prevalence and causes of postimplantation ND, duration of support until ND, time from ND to death, laboratory data and medications at the time of ND, post-ND treatment procedures, and causes of hemorrhagic ND. We also performed Cox multivariable logistic regression analysis to identify predictors of ND-related mortality by calculating odds ratios and confidence intervals. Results: Neurologic dysfunction occurred in 141 patients (26.8{\%}), 48 (9.1{\%}) of whom subsequently died. Median duration of left ventricular assist device support before ND was 230 days (range, 3 to 2,422), and median time from ND to death was 3.5 days (range, 0 to 55). Parenchymal hemorrhage was the most frequent cause of early conversion (76.7{\%}). In the Cox multivariable regression analysis, predictors of fatal ND were age, ischemic cause of heart failure, history of stroke, and longer intraoperative aortic cross-clamp time. Conclusions: Our study elucidates the characteristics and risk factors of patients who died of ND during CF-LVAD support. Further studies are required to find ways to decrease the incidence of fatal ND during CF-LVAD support.",
author = "Masashi Kawabori and Conyer, {Ryan T.} and Chitaru Kurihara and Tadahisa Sugiura and Civitello, {Andrew B.} and Frazier, {O. H.} and Morgan, {Jeffrey A.}",
year = "2019",
month = "4",
doi = "10.1016/j.athoracsur.2018.10.012",
language = "English (US)",
volume = "107",
pages = "1132--1138",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Fatal Neurologic Dysfunction During Continuous-Flow Left Ventricular Assist Device Support

AU - Kawabori, Masashi

AU - Conyer, Ryan T.

AU - Kurihara, Chitaru

AU - Sugiura, Tadahisa

AU - Civitello, Andrew B.

AU - Frazier, O. H.

AU - Morgan, Jeffrey A.

PY - 2019/4

Y1 - 2019/4

N2 - Background: During continuous-flow left ventricular assist device (CF-LVAD) support, neurologic dysfunction (ND) is a common complication and can be fatal. Few reports provide detailed data on neurologic mortality in such patients. Therefore, we examined ND-related mortality during CF-LVAD support. Methods: Between November 2003 and March 2016, 526 patients underwent implantation of a CF-LVAD (403 HeartMate II [Thoratec, Pleasanton, CA] and 123 HVAD [HeartWare International, Framingham, MA]) at our center. We categorized ND as hemorrhagic or ischemic and recorded resulting deaths. Records were reviewed to determine preoperative demographics, perioperative variables, prevalence and causes of postimplantation ND, duration of support until ND, time from ND to death, laboratory data and medications at the time of ND, post-ND treatment procedures, and causes of hemorrhagic ND. We also performed Cox multivariable logistic regression analysis to identify predictors of ND-related mortality by calculating odds ratios and confidence intervals. Results: Neurologic dysfunction occurred in 141 patients (26.8%), 48 (9.1%) of whom subsequently died. Median duration of left ventricular assist device support before ND was 230 days (range, 3 to 2,422), and median time from ND to death was 3.5 days (range, 0 to 55). Parenchymal hemorrhage was the most frequent cause of early conversion (76.7%). In the Cox multivariable regression analysis, predictors of fatal ND were age, ischemic cause of heart failure, history of stroke, and longer intraoperative aortic cross-clamp time. Conclusions: Our study elucidates the characteristics and risk factors of patients who died of ND during CF-LVAD support. Further studies are required to find ways to decrease the incidence of fatal ND during CF-LVAD support.

AB - Background: During continuous-flow left ventricular assist device (CF-LVAD) support, neurologic dysfunction (ND) is a common complication and can be fatal. Few reports provide detailed data on neurologic mortality in such patients. Therefore, we examined ND-related mortality during CF-LVAD support. Methods: Between November 2003 and March 2016, 526 patients underwent implantation of a CF-LVAD (403 HeartMate II [Thoratec, Pleasanton, CA] and 123 HVAD [HeartWare International, Framingham, MA]) at our center. We categorized ND as hemorrhagic or ischemic and recorded resulting deaths. Records were reviewed to determine preoperative demographics, perioperative variables, prevalence and causes of postimplantation ND, duration of support until ND, time from ND to death, laboratory data and medications at the time of ND, post-ND treatment procedures, and causes of hemorrhagic ND. We also performed Cox multivariable logistic regression analysis to identify predictors of ND-related mortality by calculating odds ratios and confidence intervals. Results: Neurologic dysfunction occurred in 141 patients (26.8%), 48 (9.1%) of whom subsequently died. Median duration of left ventricular assist device support before ND was 230 days (range, 3 to 2,422), and median time from ND to death was 3.5 days (range, 0 to 55). Parenchymal hemorrhage was the most frequent cause of early conversion (76.7%). In the Cox multivariable regression analysis, predictors of fatal ND were age, ischemic cause of heart failure, history of stroke, and longer intraoperative aortic cross-clamp time. Conclusions: Our study elucidates the characteristics and risk factors of patients who died of ND during CF-LVAD support. Further studies are required to find ways to decrease the incidence of fatal ND during CF-LVAD support.

UR - http://www.scopus.com/inward/record.url?scp=85061901962&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061901962&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2018.10.012

DO - 10.1016/j.athoracsur.2018.10.012

M3 - Article

C2 - 30465757

AN - SCOPUS:85061901962

VL - 107

SP - 1132

EP - 1138

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 4

ER -