Incidence and impact of ischemic and hemorrhagic stroke after left ventricular assist device implantation: A nationwide study

BACKGROUND: Despite noteworthy advancements in the design of the left ventricular assist device (LVAD), stroke remains one of the most significant adverse events. This study aims to analyze the incidence and short-term outcomes associated with stroke (ischemic and hemorrhagic) after implantation of LVAD. METHODS: Study cohorts were identified from the National Inpatient Sample database from January 2009 to September 2015 using the International Classification of Diseases, Ninth Revision codes. The primary outcome was an incidence of stroke, and secondary outcomes were the associated mortality, length of stay, and cost of hospitalization. A multivariate logistic regression analysis was performed to analyze adjusted in-hospital mortality. RESULTS: Use of LVADs increased significantly from 2009 to 2014 (2278 in 2009 to 3730 in 2014 [P(trend) <0.001]). From a total of 20,656 admissions who underwent LVAD implantation, 1518 (7.4%) developed stroke, among whom 1177 (5.7%) had an ischemic stroke and 426 (2.1%) had a hemorrhagic stroke. Adjusted in-hospital mortality was highest with hemorrhagic stroke. Incidence of stroke was associated with significantly longer length of stay and cost of hospitalization. CONCLUSION: The incidence of stroke was ~7% after LVAD placement, and it was associated with significantly higher in-hospital mortality and resource utilization.