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Implications of Causes of Intracranial Hemorrhage During Left Ventricular Assist Device Support

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Abstract

Background

Intracranial hemorrhage (ICH) is a frequent complication in patients with an implanted left ventricular assist device (LVAD) for advanced heart failure. Bloodstream infection is known to be associated with ICH in patients with LVAD, but its effects on ICH-associated mortality are unknown. We compared characteristics and mortality of infection-associated, traumatic, and spontaneous hemorrhages.

Methods

Patients in an LVAD registry at a tertiary care center were reviewed for this cohort study. ICH included intraparenchymal hemorrhage, subarachnoid hemorrhage, and subdural hemorrhage. Hemorrhages were categorized into infectious, traumatic, and spontaneous by the presence or absence of concurrent device-associated infection or antecedent trauma.

Results

Of 683 patients with an LVAD, 73 experienced ICH (10.7%). Intraparenchymal hemorrhage was the most prevalent (72%), followed by subarachnoid hemorrhage (27%) and subdural hemorrhage (23%), with multiple concurrent hemorrhage subtypes in 16 patients (22%). Median time from implantation to ICH was shorter in spontaneous ICH than in infection-associated ICH (100 days vs. 252 days, p = 0.048). The prevalence of the different subtypes of ICH were similar between spontaneous and infection-associated ICH, and no differences were seen in mortality between the different causes of ICH.

Conclusions

Although spontaneous ICH occurred earlier after LVAD implantation than infection-associated ICH, no difference in mortality was seen between the different causes of ICH.

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Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Aaron Shoskes & Aron Gedansky

  2. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Catherine Hassett & Ken Uchino

  3. Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA

    Randall Carson Starling & Jerry D. Estep

  4. Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA

    Michael Z. Y. Tong

  5. Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Sung-Min Cho

Authors
  1. Aaron Shoskes
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  2. Catherine Hassett
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  3. Aron Gedansky
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  4. Randall Carson Starling
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  6. Michael Z. Y. Tong
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  7. Sung-Min Cho
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  8. Ken Uchino
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Contributions

AS: conception and design, acquisition and interpretation of data, and drafting the article. CH: conception and design, interpretation of data, and revising the article. AG: conception and design, interpretation of data, and revising the article. RCS: conception and design, interpretation of data, and revising the article. JDE: conception and design, interpretation of data, and revising the article. MZYT: conception and design, interpretation of data, and revising the article. S-MC: conception and design, interpretation of data, and revising the article. KU: conception and design, interpretation of data, and revising the article. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Ken Uchino.

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Conflicts of interest

Ken Uchino serves on the data safety monitoring board of a study of LVAD device sponsored by Evaheart, Inc. Other authors have no conflicts to disclose.

Ethical approval/informed consent

This study adhered to ethical guidelines and was approved by the local institutional review board (Cleveland Clinic institutional review board number 17-363).

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Shoskes, A., Hassett, C., Gedansky, A. et al. Implications of Causes of Intracranial Hemorrhage During Left Ventricular Assist Device Support. Neurocrit Care 37, 267–272 (2022). https://doi.org/10.1007/s12028-022-01494-3

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  • DOI: https://doi.org/10.1007/s12028-022-01494-3

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