Adverse neurologic events in patients bridged with long-term mechanical circulatory support: A device-specific comparative analysis

Mechanical Circulatory Support Research Network

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background Neurologic complications are among the principal causes of morbidity and mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation. The aim of this study was to describe a focused "real-world" multicenter comparison of neurologic outcomes between HeartMate II (HMII) and HeartWare HVAD CF-LVAD recipients. Methods Between March 2009 and October 2014, 497 patients underwent primary CF-LVAD implantation as a bridge to transplantation at centers included in the Mechanical Circulatory Support Research Network; 314 patients (63%) received HMII, and 183 patients (37%) received HVAD. Ischemic cerebrovascular accident, hemorrhagic cerebrovascular accident, and transient ischemic attack were the neurologic outcomes assessed. Results Median follow-up time for HMII recipients was 0.95 years (0.48, 1.85, range) and for HVAD recipients was 0.44 years (0.19, 0.97, range) (p <0.001). HMII recipients had significantly fewer neurologic events per patient year for ischemic cerebrovascular accident (0.071) and transient ischemic attack (0.012) compared with HVAD recipients (0.157 and 0.072, respectively). Univariate analysis showed that 51 HMII recipients (16%) had any neurologic event, whereas 34 HVAD recipients (19%) had any neurologic event (p = 0.504). After adjusting for pre-specified covariates (device type, age, sex, atrial fibrillation, diabetes, and Interagency Registry for Mechanically Assisted Circulatory Support profile), multivariable analysis showed only advanced age was able to predict neurologic events (p = 0.02). Neurologic events were comparable between HMII and HVAD recipients after multivariable analysis. Conclusions CF-LVAD placement incurs a low but significant risk of neurologic complications in patients receiving CF-LVADs as a bridge to transplantation. Advancing age is a risk factor for any adverse neurologic outcome. This multicenter analysis demonstrated comparable hazard of adverse neurologic events among patients implanted with HMII or HVAD.

Original languageEnglish (US)
Pages (from-to)1578-1585
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Nervous System
Equipment and Supplies
Heart-Assist Devices
Stroke
Transient Ischemic Attack
Transplantation
Atrial Fibrillation
Registries
Morbidity
Mortality

Keywords

  • adult
  • adverse event
  • complications
  • mechanical circulatory support
  • neurological

ASJC Scopus subject areas

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

Cite this

Adverse neurologic events in patients bridged with long-term mechanical circulatory support : A device-specific comparative analysis. / Mechanical Circulatory Support Research Network.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 12, 01.12.2015, p. 1578-1585.

Research output: Contribution to journalArticle

@article{25e20046fb504c0c867226bfb7815505,
title = "Adverse neurologic events in patients bridged with long-term mechanical circulatory support: A device-specific comparative analysis",
abstract = "Background Neurologic complications are among the principal causes of morbidity and mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation. The aim of this study was to describe a focused {"}real-world{"} multicenter comparison of neurologic outcomes between HeartMate II (HMII) and HeartWare HVAD CF-LVAD recipients. Methods Between March 2009 and October 2014, 497 patients underwent primary CF-LVAD implantation as a bridge to transplantation at centers included in the Mechanical Circulatory Support Research Network; 314 patients (63{\%}) received HMII, and 183 patients (37{\%}) received HVAD. Ischemic cerebrovascular accident, hemorrhagic cerebrovascular accident, and transient ischemic attack were the neurologic outcomes assessed. Results Median follow-up time for HMII recipients was 0.95 years (0.48, 1.85, range) and for HVAD recipients was 0.44 years (0.19, 0.97, range) (p <0.001). HMII recipients had significantly fewer neurologic events per patient year for ischemic cerebrovascular accident (0.071) and transient ischemic attack (0.012) compared with HVAD recipients (0.157 and 0.072, respectively). Univariate analysis showed that 51 HMII recipients (16{\%}) had any neurologic event, whereas 34 HVAD recipients (19{\%}) had any neurologic event (p = 0.504). After adjusting for pre-specified covariates (device type, age, sex, atrial fibrillation, diabetes, and Interagency Registry for Mechanically Assisted Circulatory Support profile), multivariable analysis showed only advanced age was able to predict neurologic events (p = 0.02). Neurologic events were comparable between HMII and HVAD recipients after multivariable analysis. Conclusions CF-LVAD placement incurs a low but significant risk of neurologic complications in patients receiving CF-LVADs as a bridge to transplantation. Advancing age is a risk factor for any adverse neurologic outcome. This multicenter analysis demonstrated comparable hazard of adverse neurologic events among patients implanted with HMII or HVAD.",
keywords = "adult, adverse event, complications, mechanical circulatory support, neurological",
author = "{Mechanical Circulatory Support Research Network} and Coffin, {Samuel T.} and Haglund, {Nicholas A.} and Davis, {Mary E.} and Meng Xu and Dunlay, {Shannon M} and Cowger, {Jennifer A.} and Palak Shah and Aaronson, {Keith D.} and Pagani, {Frank D.} and Stulak, {John M.} and Simon Maltais",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.healun.2015.08.017",
language = "English (US)",
volume = "34",
pages = "1578--1585",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "12",

}

TY - JOUR

T1 - Adverse neurologic events in patients bridged with long-term mechanical circulatory support

T2 - A device-specific comparative analysis

AU - Mechanical Circulatory Support Research Network

AU - Coffin, Samuel T.

AU - Haglund, Nicholas A.

AU - Davis, Mary E.

AU - Xu, Meng

AU - Dunlay, Shannon M

AU - Cowger, Jennifer A.

AU - Shah, Palak

AU - Aaronson, Keith D.

AU - Pagani, Frank D.

AU - Stulak, John M.

AU - Maltais, Simon

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background Neurologic complications are among the principal causes of morbidity and mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation. The aim of this study was to describe a focused "real-world" multicenter comparison of neurologic outcomes between HeartMate II (HMII) and HeartWare HVAD CF-LVAD recipients. Methods Between March 2009 and October 2014, 497 patients underwent primary CF-LVAD implantation as a bridge to transplantation at centers included in the Mechanical Circulatory Support Research Network; 314 patients (63%) received HMII, and 183 patients (37%) received HVAD. Ischemic cerebrovascular accident, hemorrhagic cerebrovascular accident, and transient ischemic attack were the neurologic outcomes assessed. Results Median follow-up time for HMII recipients was 0.95 years (0.48, 1.85, range) and for HVAD recipients was 0.44 years (0.19, 0.97, range) (p <0.001). HMII recipients had significantly fewer neurologic events per patient year for ischemic cerebrovascular accident (0.071) and transient ischemic attack (0.012) compared with HVAD recipients (0.157 and 0.072, respectively). Univariate analysis showed that 51 HMII recipients (16%) had any neurologic event, whereas 34 HVAD recipients (19%) had any neurologic event (p = 0.504). After adjusting for pre-specified covariates (device type, age, sex, atrial fibrillation, diabetes, and Interagency Registry for Mechanically Assisted Circulatory Support profile), multivariable analysis showed only advanced age was able to predict neurologic events (p = 0.02). Neurologic events were comparable between HMII and HVAD recipients after multivariable analysis. Conclusions CF-LVAD placement incurs a low but significant risk of neurologic complications in patients receiving CF-LVADs as a bridge to transplantation. Advancing age is a risk factor for any adverse neurologic outcome. This multicenter analysis demonstrated comparable hazard of adverse neurologic events among patients implanted with HMII or HVAD.

AB - Background Neurologic complications are among the principal causes of morbidity and mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation. The aim of this study was to describe a focused "real-world" multicenter comparison of neurologic outcomes between HeartMate II (HMII) and HeartWare HVAD CF-LVAD recipients. Methods Between March 2009 and October 2014, 497 patients underwent primary CF-LVAD implantation as a bridge to transplantation at centers included in the Mechanical Circulatory Support Research Network; 314 patients (63%) received HMII, and 183 patients (37%) received HVAD. Ischemic cerebrovascular accident, hemorrhagic cerebrovascular accident, and transient ischemic attack were the neurologic outcomes assessed. Results Median follow-up time for HMII recipients was 0.95 years (0.48, 1.85, range) and for HVAD recipients was 0.44 years (0.19, 0.97, range) (p <0.001). HMII recipients had significantly fewer neurologic events per patient year for ischemic cerebrovascular accident (0.071) and transient ischemic attack (0.012) compared with HVAD recipients (0.157 and 0.072, respectively). Univariate analysis showed that 51 HMII recipients (16%) had any neurologic event, whereas 34 HVAD recipients (19%) had any neurologic event (p = 0.504). After adjusting for pre-specified covariates (device type, age, sex, atrial fibrillation, diabetes, and Interagency Registry for Mechanically Assisted Circulatory Support profile), multivariable analysis showed only advanced age was able to predict neurologic events (p = 0.02). Neurologic events were comparable between HMII and HVAD recipients after multivariable analysis. Conclusions CF-LVAD placement incurs a low but significant risk of neurologic complications in patients receiving CF-LVADs as a bridge to transplantation. Advancing age is a risk factor for any adverse neurologic outcome. This multicenter analysis demonstrated comparable hazard of adverse neurologic events among patients implanted with HMII or HVAD.

KW - adult

KW - adverse event

KW - complications

KW - mechanical circulatory support

KW - neurological

UR - http://www.scopus.com/inward/record.url?scp=84949757789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84949757789&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2015.08.017

DO - 10.1016/j.healun.2015.08.017

M3 - Article

C2 - 26522376

AN - SCOPUS:84949757789

VL - 34

SP - 1578

EP - 1585

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 12

ER -