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Cerebrovascular Events in Children on Intracorporeal Continuous-Flow Left Ventricular Assist Devices.

PURPOSE
Continuous flow intracorporeal left ventricular assist devices (CF-LVAD) are used more frequently in pediatric population. One of the major complications of CF-LVAD is cerebrovascular events(CVE). Limited information is available on this complication in pediatric patients. We hereby present our experience on CVE in children under CF-LVAD support in our institution.


METHODS
A retrospective, single center review of 21 patients younger than 19 years of age who underwent CF-LVAD implantation between June 2014 and September 2018 was performed. Patients on biventricular support and extracorporeal device were excluded. Cerebrovascular accidents-ischemic or hemorrhagic-were investigated. CVE was confirmed by brain computed tomographic scan.


RESULTS
Of twenty-one pediatric patients, 11 was male. Mean BSA was 1.05±0.41 m2 and mean age was 11.05±4.07 years. Dilated cardiomyopathy was the leading cause of heart failure. The patients were implanted HeartWare hVAD (n=19), Heartmate II (n=1) and Heartmate III (n=1). Mean support time was 421±448(18-1460) days. Target international normalized ratio was between 2.5-3.0. Nine(43%) patients underwent transplantation, 1 patient recovered with subsequent device explantation. Four(17%) patients were still on support. One patient(5%) died in early postoperative period and 6(28%) patients died on VAD support after mean duration of 194 days. There were overall 5 cerebral hemorrhagic strokes in 4 patients(0.2 events per patient-year). CVA occurred between 250 and 1320 days(mean 600 days). No ischemic stroke was documented. Only one(20%) patient died after hemorrhagic stroke; other 3 patients recovered and were discharged from the hospital with minor sequelaes.


CONCLUSION
Incidence of CVE in children on CF-LVAD is relatively low compared with adults on VAD and severity of stroke is milder than adult population.