NEUROLOGICAL complications during magnetically levitated left ventricular assist device (LVAD) support were associated with substantially reduced survival among patients with advanced heart failure, according to a multicentre analysis of 11,739 patients. Both stroke and nonstroke neurological adverse events were linked to an increased risk of death, highlighting the importance of recognising and addressing neurological dysfunction during long term mechanical circulatory support.
Researchers analysed data from the US based Society of Thoracic Surgeons INTERMACS database in a retrospective cohort study covering 1 January 2017 to 31 March 2023. The study examined the incidence, prognostic implications and risk factors of stroke and nonstroke neurological adverse events during support with contemporary magnetically levitated LVADs.
Among the 11,739 patients included, 879 (8%) experienced a stroke, while 972 (8%) developed a nonstroke neurological adverse event. The remaining 9,888 patients (84%) had no recorded neurological adverse event during a median follow up of 1.4 years.
At two years, survival while receiving LVAD support was 45% among patients who experienced a stroke and 56% among those with nonstroke neurological adverse events. Both outcomes were associated with significantly poorer survival than the absence of neurological complications.
The analysis found that the risk of death was 7.3 times higher following stroke and 5.1 times higher following a nonstroke neurological adverse event compared with patients who experienced no neurological adverse event.
Factors associated with mortality after stroke included older age, a preimplantation implantable cardioverter defibrillator, higher blood urea nitrogen levels and preimplantation dialysis. Following nonstroke neurological adverse events, mortality was associated with higher preimplantation body mass index, serum creatinine and international normalised ratio, alongside lower albumin levels.
These findings indicate that neurological complications represent an important prognostic concern during LVAD therapy, extending beyond stroke alone. The similar proportions of patients experiencing stroke and nonstroke events also highlight the need to recognise both categories when assessing treatment safety.
Preimplantation extracorporeal membrane oxygenation and concomitant surgery were associated with the occurrence of both stroke and nonstroke neurological adverse events. These factors may represent potential targets for strategies aimed at reducing neurological complications, although the observational study does not establish causation.
The authors called for stroke and nonstroke neurological adverse events to receive comparable consideration, supported by consistent terminology when evaluating durable LVAD safety. Their findings underscore the importance of comprehensive neurological risk assessment and further investigation into potentially modifiable risk factors in patients with advanced heart failure receiving mechanical circulatory support.
Reference
Saeed O et al. Neurological dysfunction during contemporary magnetically levitated left ventricular assist device support for advanced heart failure: an STS-INTERMACS analysis. JACC Heart Fail. 2026. [Epub ahead of print].
Featured Image: ungvar on Adobe Stock
Featured Image: ungvar on Adobe Stock
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