Intracranial Hemorrhage in Patients with a Left Ventricular Assist Device
Tahir RA, Rotman LE, Davis MC, Dupepe EB, Kole MK, Rahman M, Williams CT, Pamboukian SV, Bazydlo M, and Walters BC. Intracranial hemorrhage in patients with a left ventricular assist device. World Neurosurg 2018; 113:e714-e721.
BACKGROUND: There is a dearth of literature regarding management and outcomes of patients with a left ventricular assist device (LVAD) for advanced heart failure who develop intracranial hemorrhage (ICH). We conducted a case series from 2 centers highlighting patient outcomes and prognostic factors to help clinicians better understand and care for these high-risk patients.
METHODS: A case series from 2 large-volume institutions (defined as large by the Nationwide Inpatient Sample hospital size, i.e., >500 beds both with Departments of Neurosurgery and Advanced Heart Failure-Cardiology) was conducted to clarify the prognosis of patients with an LVAD and ICH. We included patients who were being treated with an LVAD who developed ICH. Patient-specific demographics and data regarding heart failure and intracranial hemorrhage characteristics were collected and analyzed to determine which factors contributed to overall survival.
RESULTS: We analyzed 59 unique ICHs in patients being treated with an LVAD for heart failure. Initial Glasgow Coma Scale score, presence of midline shift, and ICH size were factors found to be predictive of mortality. One institution had a sicker patient population including patients with ICH with lower Glasgow Coma Scale score, presence of midline shift, and greater hemorrhage size, which led to overall higher mortality compared with the second institution.
CONCLUSIONS: Patients being treated with an LVAD who develop ICH have poor outcomes. Predictive factors for same-admission mortality are lower initial Glasgow Coma Scale score, presence of midline shift, and greater ICH volume.
Medical Subject Headings
Female; Follow-Up Studies; Heart Ventricles; Heart-Assist Devices; Hospital Mortality; Humans; Intracranial Hemorrhages; Male; Middle Aged; Retrospective Studies