The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure

Katherine Lietz, Kevin Brown, Syed S. Ali, Monica Colvin-Adams, Andrew J. Boyle, David Anderson, Alan D. Weinberg, Leslie W. Miller, Soon Park, Ranjit John, Ronald M. Lazar

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: Cerebral hyperperfusion is a life-threatening syndrome that can occur in patients with chronically hypoperfused cerebral vasculature whose normal cerebral circulation was re-established after carotid endarterectomy or angioplasty. We sought to determine whether the abrupt restoration of perfusion to the brain after left ventricular assist device (LVAD) implantation produced similar syndromes. Methods: We studied the role of increased systemic flow after LVAD implantation on neurologic dysfunction in 69 consecutive HeartMate XVE LVAD (Thoratec, Pleasanton, Calif) recipients from October 2001 through June 2006. Neurologic dysfunction was defined as postoperative permanent or transient central change in neurologic status, including confusion, focal neurologic deficits, visual changes, seizures, or coma for more than 24 hours within 30 days after LVAD implantation. Results: We found that 19 (27.5%) patients had neurologic dysfunction, including encephalopathy (n = 11), coma (n = 3), and other complications (n = 5). The multivariate analysis showed that an increase in cardiac index from the preoperative baseline value (relative risk, 1.33 per 25% cardiac index increase; P = .01) and a previous coronary bypass operation (relative risk, 4.53; P = .02) were the only independent predictors of neurologic dysfunction. Reduction of left ventricular assist device flow in 16 of the 19 symptomatic patients led to improvement of symptoms in 14 (87%) patients. Conclusions: Our findings showed that normal flow might overwhelm cerebral autoregulation in patients with severe heart failure, suggesting that cerebral hyperperfusion is possible in recipients of mechanical circulatory support with neurologic dysfunction.

Original languageEnglish (US)
Pages (from-to)1012-1019
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number4
DOIs
StatePublished - Apr 2009

Fingerprint

Heart-Assist Devices
Neurologic Manifestations
Heart Failure
Coma
Cerebrovascular Circulation
Carotid Endarterectomy
Brain Diseases
Angioplasty
Nervous System
Seizures
Homeostasis
Multivariate Analysis
Perfusion
Brain

ASJC Scopus subject areas

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

Cite this

The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure. / Lietz, Katherine; Brown, Kevin; Ali, Syed S.; Colvin-Adams, Monica; Boyle, Andrew J.; Anderson, David; Weinberg, Alan D.; Miller, Leslie W.; Park, Soon; John, Ranjit; Lazar, Ronald M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 137, No. 4, 04.2009, p. 1012-1019.

Research output: Contribution to journalArticle

Lietz, K, Brown, K, Ali, SS, Colvin-Adams, M, Boyle, AJ, Anderson, D, Weinberg, AD, Miller, LW, Park, S, John, R & Lazar, RM 2009, 'The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure', Journal of Thoracic and Cardiovascular Surgery, vol. 137, no. 4, pp. 1012-1019. https://doi.org/10.1016/j.jtcvs.2008.11.034
Lietz, Katherine ; Brown, Kevin ; Ali, Syed S. ; Colvin-Adams, Monica ; Boyle, Andrew J. ; Anderson, David ; Weinberg, Alan D. ; Miller, Leslie W. ; Park, Soon ; John, Ranjit ; Lazar, Ronald M. / The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure. In: Journal of Thoracic and Cardiovascular Surgery. 2009 ; Vol. 137, No. 4. pp. 1012-1019.
@article{2f2120a93d22400db5caf0f6279e1956,
title = "The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure",
abstract = "Objective: Cerebral hyperperfusion is a life-threatening syndrome that can occur in patients with chronically hypoperfused cerebral vasculature whose normal cerebral circulation was re-established after carotid endarterectomy or angioplasty. We sought to determine whether the abrupt restoration of perfusion to the brain after left ventricular assist device (LVAD) implantation produced similar syndromes. Methods: We studied the role of increased systemic flow after LVAD implantation on neurologic dysfunction in 69 consecutive HeartMate XVE LVAD (Thoratec, Pleasanton, Calif) recipients from October 2001 through June 2006. Neurologic dysfunction was defined as postoperative permanent or transient central change in neurologic status, including confusion, focal neurologic deficits, visual changes, seizures, or coma for more than 24 hours within 30 days after LVAD implantation. Results: We found that 19 (27.5{\%}) patients had neurologic dysfunction, including encephalopathy (n = 11), coma (n = 3), and other complications (n = 5). The multivariate analysis showed that an increase in cardiac index from the preoperative baseline value (relative risk, 1.33 per 25{\%} cardiac index increase; P = .01) and a previous coronary bypass operation (relative risk, 4.53; P = .02) were the only independent predictors of neurologic dysfunction. Reduction of left ventricular assist device flow in 16 of the 19 symptomatic patients led to improvement of symptoms in 14 (87{\%}) patients. Conclusions: Our findings showed that normal flow might overwhelm cerebral autoregulation in patients with severe heart failure, suggesting that cerebral hyperperfusion is possible in recipients of mechanical circulatory support with neurologic dysfunction.",
author = "Katherine Lietz and Kevin Brown and Ali, {Syed S.} and Monica Colvin-Adams and Boyle, {Andrew J.} and David Anderson and Weinberg, {Alan D.} and Miller, {Leslie W.} and Soon Park and Ranjit John and Lazar, {Ronald M.}",
year = "2009",
month = "4",
doi = "10.1016/j.jtcvs.2008.11.034",
language = "English (US)",
volume = "137",
pages = "1012--1019",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - The role of cerebral hyperperfusion in postoperative neurologic dysfunction after left ventricular assist device implantation for end-stage heart failure

AU - Lietz, Katherine

AU - Brown, Kevin

AU - Ali, Syed S.

AU - Colvin-Adams, Monica

AU - Boyle, Andrew J.

AU - Anderson, David

AU - Weinberg, Alan D.

AU - Miller, Leslie W.

AU - Park, Soon

AU - John, Ranjit

AU - Lazar, Ronald M.

PY - 2009/4

Y1 - 2009/4

N2 - Objective: Cerebral hyperperfusion is a life-threatening syndrome that can occur in patients with chronically hypoperfused cerebral vasculature whose normal cerebral circulation was re-established after carotid endarterectomy or angioplasty. We sought to determine whether the abrupt restoration of perfusion to the brain after left ventricular assist device (LVAD) implantation produced similar syndromes. Methods: We studied the role of increased systemic flow after LVAD implantation on neurologic dysfunction in 69 consecutive HeartMate XVE LVAD (Thoratec, Pleasanton, Calif) recipients from October 2001 through June 2006. Neurologic dysfunction was defined as postoperative permanent or transient central change in neurologic status, including confusion, focal neurologic deficits, visual changes, seizures, or coma for more than 24 hours within 30 days after LVAD implantation. Results: We found that 19 (27.5%) patients had neurologic dysfunction, including encephalopathy (n = 11), coma (n = 3), and other complications (n = 5). The multivariate analysis showed that an increase in cardiac index from the preoperative baseline value (relative risk, 1.33 per 25% cardiac index increase; P = .01) and a previous coronary bypass operation (relative risk, 4.53; P = .02) were the only independent predictors of neurologic dysfunction. Reduction of left ventricular assist device flow in 16 of the 19 symptomatic patients led to improvement of symptoms in 14 (87%) patients. Conclusions: Our findings showed that normal flow might overwhelm cerebral autoregulation in patients with severe heart failure, suggesting that cerebral hyperperfusion is possible in recipients of mechanical circulatory support with neurologic dysfunction.

AB - Objective: Cerebral hyperperfusion is a life-threatening syndrome that can occur in patients with chronically hypoperfused cerebral vasculature whose normal cerebral circulation was re-established after carotid endarterectomy or angioplasty. We sought to determine whether the abrupt restoration of perfusion to the brain after left ventricular assist device (LVAD) implantation produced similar syndromes. Methods: We studied the role of increased systemic flow after LVAD implantation on neurologic dysfunction in 69 consecutive HeartMate XVE LVAD (Thoratec, Pleasanton, Calif) recipients from October 2001 through June 2006. Neurologic dysfunction was defined as postoperative permanent or transient central change in neurologic status, including confusion, focal neurologic deficits, visual changes, seizures, or coma for more than 24 hours within 30 days after LVAD implantation. Results: We found that 19 (27.5%) patients had neurologic dysfunction, including encephalopathy (n = 11), coma (n = 3), and other complications (n = 5). The multivariate analysis showed that an increase in cardiac index from the preoperative baseline value (relative risk, 1.33 per 25% cardiac index increase; P = .01) and a previous coronary bypass operation (relative risk, 4.53; P = .02) were the only independent predictors of neurologic dysfunction. Reduction of left ventricular assist device flow in 16 of the 19 symptomatic patients led to improvement of symptoms in 14 (87%) patients. Conclusions: Our findings showed that normal flow might overwhelm cerebral autoregulation in patients with severe heart failure, suggesting that cerebral hyperperfusion is possible in recipients of mechanical circulatory support with neurologic dysfunction.

UR - http://www.scopus.com/inward/record.url?scp=62849126100&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=62849126100&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2008.11.034

DO - 10.1016/j.jtcvs.2008.11.034

M3 - Article

C2 - 19327532

AN - SCOPUS:62849126100

VL - 137

SP - 1012

EP - 1019

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -