Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death

Overview

Journal J Card Fail

Specialty Cardiology & Vascular Diseases

Date 2021 Jun 23

PMID 34161806

Citations 5

Authors

Claudio A Bravo

Justin A Fried

Joshua Z Willey

Azka Javaid

Giulio M Mondellini

Lorenzo Braghieri

Heidi Lumish

Veli K Topkara

Yuji Kaku

Lucas Witer

Hiroo Takayama

Koji Takeda

Gabriel Sayer

Nir Uriel

Ryan T Demmer

Yoshifumi Naka

Melana Yuzefpolskaya

Paolo C Colombo

Affiliations

Soon will be listed here.

Abstract

Background: Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population.

Methods And Results: We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.00-3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95% CI 1.14-5.28, P = .021) and death (HR 2.36, 95% CI 1.17-4.79 P = .016) at 6 months of follow-up.

Conclusions: The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.

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