Pre-Operative Intracardiac Thrombus is Associated with Increased Risk of Stroke and Death in CF-LVAD Patients
| Autor: | Joshua Z. Willey, Hiroo Takayama, C.A. Bravo Carillo, Yuji Kaku, L. Braghieri, Justin Fried, Veli K. Topkara, L. Witer, Melana Yuzefpolskaya, H. Lumish, Koji Takeda, Nir Uriel, A. Javaid, Y. Naka, G.M. Mondellini, Paolo C. Colombo |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Transplantation medicine.medical_specialty business.industry Atrial Appendage Atrial fibrillation medicine.disease Internal medicine Heart failure medicine Operative report Cardiology Surgery cardiovascular diseases Implant Thrombus Cardiology and Cardiovascular Medicine business Ligation Stroke |
| Zdroj: | The Journal of Heart and Lung Transplantation. 39:S148-S149 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2020.01.1079 |
| Popis: | Purpose Advanced heart failure predisposes patients to intracardiac thrombus (ICT) formation. There is a paucity of evidence examining the impact of pre-existing left atrial (LA) or left ventricular (LV) thrombi on post-operative outcomes in patients undergoing durable LVAD implantation. Methods We retrospectively reviewed 525 LVAD patients (374 HMII, 151 HM3) from 2/2009 through 3/2019. Transthoracic echocardiography (TTE) within 1 month of implant, intra-operative transesophageal echocardiography (TEE), and operative reports were reviewed to identify patients with pre-existing ICT at the time of LVAD surgery. The primary outcome was a composite of stroke or death at 6 months. Results Of the 525 patients (age 58±1 years, 81.5% male, 46% ICM) who underwent device implantation during the study period, 41 (7.8%) had a pre-existing ICT (16 in LA, 22 in LV and 3 in both). Patients with ICT had higher mortality (24.4% vs. 9.3%; p=0.002) and higher stroke rate (17.1% vs. 7.6%; p=0.036) at 6 months compared to patients without thrombus. Survival free from stroke and freedom from stroke in the two groups is shown in Figure 1a and 1b. In a multivariable model including age, gender, history of stroke, history of atrial fibrillation/flutter, atrial appendage ligation, and device type, ICT was found to be the only independent predictor of death or stroke at 6 months (HR 2.07, 95% CI 1.10 - 3.89). No stroke or deaths occurred in the 7 HM3 patients who had ICT prior to surgery. Conclusion Pre-existing ICT is associated with decreased survival free of stroke following LVAD implantation. Additional studies are warranted to assess the optimal risk stratification and management of these patients. |
| Databáze: | OpenAIRE |
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