E-resources
-
Teuteberg, Jeffrey J; Slaughter, Mark S; Rogers, Joseph G; McGee, Edwin C; Pagani, Francis D; Gordon, Robert; Rame, Eduardo; Acker, Michael; Kormos, Robert L; Salerno, Christopher; Schleeter, Thomas P; Goldstein, Daniel J; Shin, Julia; Starling, Randall C; Wozniak, Thomas; Malik, Adnan S; Silvestry, Scott; Ewald, Gregory A; Jorde, Ulrich P; Naka, Yoshifumi; Birks, Emma; Najarian, Kevin B; Hathaway, David R; Aaronson, Keith D
JACC. Heart failure 3, Issue: 10Journal Article
The purpose of this study was to determine the risk factors for ischemic in hemorrhage cerebrovascular events in patients supported by the HeartWare ventricular assist device (HVAD). Patients supported with left ventricular assist devices are at risk for both ischemic and hemorrhagic cerebrovascular events. Patients undergoing implantation with a HVAD as part of the bridge-to-transplant trial and subsequent continued access protocol were included. Neurological events (ischemic cerebrovascular accidents ICVAs and hemorrhagic cerebrovascular accidents HCVAs) were assessed, and the risk factors for these events were evaluated in a multivariable model. A total of 382 patients were included: 140 bridge-to-transplant patients from the ADVANCE (Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure) clinical trial and 242 patients from the continued access protocol. Patients had a mean age of 53.2 years; 71.2% were male, and 68.1% were white. Thirty-eight percent had ischemic heart disease, and the mean duration of support was 422.7 days. The overall prevalence of ICVA was 6.8% (26 of 382); for HCVA, it was 8.4% (32 of 382). Pump design modifications and a protocol-driven change in the antiplatelet therapy reduced the prevalence of ICVA from 6.3% (17 of 272) to 2.7% (3 of 110; p = 0.21) but had a negligible effect on the prevalence of HVCA (8.8% 24 of 272 vs. 6.4% 7 of 110; p = 0.69). Multivariable predictors of ICVA were aspirin ≤81 mg and atrial fibrillation; predictors of HCVA were mean arterial pressure >90 mm Hg, aspirin ≤81 mg, and an international normalized ratio >3.0. Eight of the 30 participating sites had established improved blood pressure management (IBPM) protocols. Although the prevalence of ICVA for those with and without IBPM protocols was similar (5.3% 6 of 114 vs. 5.2% 14 of 268; p = 0.99), those with IBPM protocols had a significantly lower prevalence of HCVA (1.8% 2 of 114 vs. 10.8% 29 of 268; p = 0.0078). Anticoagulation, antiplatelet therapy, and blood pressure management affected the prevalence of cerebrovascular events after implantation of the HVAD. Attention to these clinical parameters can have a substantial impact on the occurrence of serious neurological events. (Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure ADVANCE; NCT00751972).
Author
Shelf entry
Permalink
- URL:
Impact factor
Access to the JCR database is permitted only to users from Slovenia. Your current IP address is not on the list of IP addresses with access permission, and authentication with the relevant AAI accout is required.
Year | Impact factor | Edition | Category | Classification | ||||
---|---|---|---|---|---|---|---|---|
JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
Select the library membership card:
If the library membership card is not in the list,
add a new one.
DRS, in which the journal is indexed
Database name | Field | Year |
---|
Links to authors' personal bibliographies | Links to information on researchers in the SICRIS system |
---|
Source: Personal bibliographies
and: SICRIS
The material is available in full text. If you wish to order the material anyway, click the Continue button.