Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry

Guglielmo Gallone; Daniel Lewin; Sebastian Rojas Hernandez; Alexander Bernhardt; Michael Billion; Anna Meyer; Ivan Netuka; J-J Kooij; Marina Pieri; Mariusz K Szymanski; Christian H Moeller; Payam Akhyari; Khalil Jawad; Ihor Krasivskyi; Bastian Schmack; Gloria Färber; Marta Medina; Assad Haneya; Daniel Zimpfer; Gaik Nersesian; Pia Lanmueller; Antonio Spitaleri; Mehmet Oezkur; Ilija Djordjevic; Diyar Saeed; Massimo Boffini; Julia Stein; F Gustafsson; Anna Mara Scandroglio; Gaetano Maria De Ferrari; Bart Meyns; Steffen Hofmann; Jan Belohlavek; Jan Gummert; Mauro Rinaldi; Evgenij V Potapov; Antonio Loforte

doi:10.1111/aor.14775

Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry

Guglielmo Gallone^*, Daniel Lewin, Sebastian Rojas Hernandez, Alexander Bernhardt, Michael Billion, Anna Meyer, Ivan Netuka, J-J Kooij, Marina Pieri, Mariusz K Szymanski, Christian H Moeller, Payam Akhyari, Khalil Jawad, Ihor Krasivskyi, Bastian Schmack, Gloria Färber, Marta Medina, Assad Haneya, Daniel Zimpfer, Gaik NersesianPia Lanmueller, Antonio Spitaleri, Mehmet Oezkur, Ilija Djordjevic, Diyar Saeed, Massimo Boffini, Julia Stein, F Gustafsson, Anna Mara Scandroglio, Gaetano Maria De Ferrari, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Mauro Rinaldi, Evgenij V Potapov, Antonio Loforte

^*Corresponding author af dette arbejde

Afdeling for Hjerte- og Lungekirurgi

3 Citationer (Scopus)

Abstract

BACKGROUND: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled.

METHODS: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied.

RESULTS: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48-65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4-22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3-85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4-18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9-4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49-7.88, p = 0.004) stroke were associated with increased 1-year mortality.

CONCLUSIONS: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.

Originalsprog	Engelsk
Tidsskrift	Artificial Organs
Vol/bind	48
Udgave nummer	10
Sider (fra-til)	1168-1179
Antal sider	12
ISSN	0160-564X
DOI	https://doi.org/10.1111/aor.14775
Status	Udgivet - okt. 2024

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10.1111/aor.14775

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Gallone, G., Lewin, D., Rojas Hernandez, S., Bernhardt, A., Billion, M., Meyer, A., Netuka, I., Kooij, J.-J., Pieri, M., Szymanski, M. K., Moeller, C. H., Akhyari, P., Jawad, K., Krasivskyi, I., Schmack, B., Färber, G., Medina, M., Haneya, A., Zimpfer, D., ... Loforte, A. (2024). Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry. Artificial Organs, 48(10), 1168-1179. https://doi.org/10.1111/aor.14775

Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry. / Gallone, Guglielmo; Lewin, Daniel; Rojas Hernandez, Sebastian et al.
I: Artificial Organs, Bind 48, Nr. 10, 10.2024, s. 1168-1179.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Gallone, G, Lewin, D, Rojas Hernandez, S, Bernhardt, A, Billion, M, Meyer, A, Netuka, I, Kooij, J-J, Pieri, M, Szymanski, MK, Moeller, CH, Akhyari, P, Jawad, K, Krasivskyi, I, Schmack, B, Färber, G, Medina, M, Haneya, A, Zimpfer, D, Nersesian, G, Lanmueller, P, Spitaleri, A, Oezkur, M, Djordjevic, I, Saeed, D, Boffini, M, Stein, J, Gustafsson, F, Scandroglio, AM, De Ferrari, GM, Meyns, B, Hofmann, S, Belohlavek, J, Gummert, J, Rinaldi, M, Potapov, EV & Loforte, A 2024, 'Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry', Artificial Organs, bind 48, nr. 10, s. 1168-1179. https://doi.org/10.1111/aor.14775

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title = "Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry",

abstract = "BACKGROUND: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled.METHODS: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied.RESULTS: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48-65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4-22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3-85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4-18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9-4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49-7.88, p = 0.004) stroke were associated with increased 1-year mortality.CONCLUSIONS: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.",

keywords = "Aged, Female, Heart Failure/therapy, Heart-Assist Devices/adverse effects, Hemorrhagic Stroke/etiology, Humans, Incidence, Ischemic Stroke/etiology, Male, Middle Aged, Registries, Retrospective Studies, Stroke/etiology, Treatment Outcome, impella, stroke, bridge strategy, outcomes, micro-axial flow pump, left ventricular assist device",

author = "Guglielmo Gallone and Daniel Lewin and {Rojas Hernandez}, Sebastian and Alexander Bernhardt and Michael Billion and Anna Meyer and Ivan Netuka and J-J Kooij and Marina Pieri and Szymanski, {Mariusz K} and Moeller, {Christian H} and Payam Akhyari and Khalil Jawad and Ihor Krasivskyi and Bastian Schmack and Gloria F{\"a}rber and Marta Medina and Assad Haneya and Daniel Zimpfer and Gaik Nersesian and Pia Lanmueller and Antonio Spitaleri and Mehmet Oezkur and Ilija Djordjevic and Diyar Saeed and Massimo Boffini and Julia Stein and F Gustafsson and Scandroglio, {Anna Mara} and {De Ferrari}, {Gaetano Maria} and Bart Meyns and Steffen Hofmann and Jan Belohlavek and Jan Gummert and Mauro Rinaldi and Potapov, {Evgenij V} and Antonio Loforte",

note = "{\textcopyright} 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.",

year = "2024",

month = oct,

doi = "10.1111/aor.14775",

language = "English",

volume = "48",

pages = "1168--1179",

journal = "Artificial Organs",

issn = "0160-564X",

publisher = "John Wiley and Sons Inc.",

number = "10",

}

TY - JOUR

T1 - Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump

T2 - Insights from a large registry

AU - Gallone, Guglielmo

AU - Lewin, Daniel

AU - Rojas Hernandez, Sebastian

AU - Bernhardt, Alexander

AU - Billion, Michael

AU - Meyer, Anna

AU - Netuka, Ivan

AU - Kooij, J-J

AU - Pieri, Marina

AU - Szymanski, Mariusz K

AU - Moeller, Christian H

AU - Akhyari, Payam

AU - Jawad, Khalil

AU - Krasivskyi, Ihor

AU - Schmack, Bastian

AU - Färber, Gloria

AU - Medina, Marta

AU - Haneya, Assad

AU - Zimpfer, Daniel

AU - Nersesian, Gaik

AU - Lanmueller, Pia

AU - Spitaleri, Antonio

AU - Oezkur, Mehmet

AU - Djordjevic, Ilija

AU - Saeed, Diyar

AU - Boffini, Massimo

AU - Stein, Julia

AU - Gustafsson, F

AU - Scandroglio, Anna Mara

AU - De Ferrari, Gaetano Maria

AU - Meyns, Bart

AU - Hofmann, Steffen

AU - Belohlavek, Jan

AU - Gummert, Jan

AU - Rinaldi, Mauro

AU - Potapov, Evgenij V

AU - Loforte, Antonio

PY - 2024/10

Y1 - 2024/10

N2 - BACKGROUND: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled.METHODS: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied.RESULTS: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48-65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4-22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3-85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4-18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9-4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49-7.88, p = 0.004) stroke were associated with increased 1-year mortality.CONCLUSIONS: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.

AB - BACKGROUND: Stroke after durable left ventricular assist device (d-LVAD) implantation portends high mortality. The incidence of ischemic and hemorrhagic stroke and the impact on stroke outcomes of temporary mechanical circulatory support (tMCS) management among patients requiring bridge to d-LVAD with micro-axial flow-pump (mAFP, Abiomed) is unsettled.METHODS: Consecutive patients, who underwent d-LVAD implantation after being bridged with mAFP at 19 institutions, were retrospectively included. The incidence of early ischemic and hemorrhagic stroke after d-LVAD implantation (<60 days) and association of pre-d-LVAD characteristics and peri-procedural management with a specific focus on tMCS strategies were studied.RESULTS: Among 341 patients, who underwent d-LVAD implantation after mAFP implantation (male gender 83.6%, age 58 [48-65] years, mAFP 5.0/5.5 72.4%), the early ischemic stroke incidence was 10.8% and early hemorrhagic stroke 2.9%. The tMCS characteristics (type of mAFP device and access, support duration, upgrade from intra-aortic balloon pump, ECMELLA, ECMELLA at d-LVAD implantation, hemolysis, and bleeding) were not associated with ischemic stroke after d-LVAD implant. Conversely, the device model (mAFP 2.5/CP vs. mAFP 5.0/5.5: HR 5.6, 95%CI 1.4-22.7, p = 0.015), hemolysis on mAFP support (HR 10.5, 95% CI 1.3-85.3, p = 0.028) and ECMELLA at d-LVAD implantation (HR 5.0, 95% CI 1.4-18.7, p = 0.016) were associated with increased risk of hemorrhagic stroke after d-LVAD implantation. Both early ischemic (HR 2.7, 95% CI 1.9-4.5, p < 0.001) and hemorrhagic (HR 3.43, 95% CI 1.49-7.88, p = 0.004) stroke were associated with increased 1-year mortality.CONCLUSIONS: Among patients undergoing d-LVAD implantation following mAFP support, tMCS characteristics do not impact ischemic stroke occurrence, while several factors are associated with hemorrhagic stroke suggesting a proactive treatment target to reduce this complication.

KW - Aged

KW - Female

KW - Heart Failure/therapy

KW - Heart-Assist Devices/adverse effects

KW - Hemorrhagic Stroke/etiology

KW - Humans

KW - Incidence

KW - Ischemic Stroke/etiology

KW - Male

KW - Middle Aged

KW - Registries

KW - Retrospective Studies

KW - Stroke/etiology

KW - Treatment Outcome

KW - impella

KW - stroke

KW - bridge strategy

KW - outcomes

KW - micro-axial flow pump

KW - left ventricular assist device

UR - http://www.scopus.com/inward/record.url?scp=85194873075&partnerID=8YFLogxK

U2 - 10.1111/aor.14775

DO - 10.1111/aor.14775

M3 - Journal article

C2 - 38803239

SN - 0160-564X

VL - 48

SP - 1168

EP - 1179

JO - Artificial Organs

JF - Artificial Organs

IS - 10

ER -

Stroke outcomes following durable left ventricular assist device implant in patients bridged with micro-axial flow pump: Insights from a large registry

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