PURPOSE: Stroke remains a major cause of morbidity and mortality in LVAD patients, with incidence upto to 22%. We hypothesized that certain LVAD cannula positions are associated with unfavourable flow patterns resulting in altered thrombogenicity, and therefore higher stroke risk. METHODS: We conducted a retrospective review of patients that underwent LVAD implantation at our institution from 2011 to 2016. All patients who underwent cardiac CT scan, were included. Patients with non-contrast CT scans, and poor quality imaging data were excluded. We studied imaging data from three modalities: X-ray, Echocardiography and cardiac CT. The primary outcome was defined as stroke within one year of LVAD implantation. RESULTS: A total of 78 patients were included in the study. The predominant device was HeartMate II (94.8%), there were three patients with HVAD and one patient with HeartMate III. Of these, 12 patients had stroke within one year of LVAD implantation: 10 were ischemic and 2 were hemorrhagic. Mean time to stroke was 108 days. There were no significant differences between the two groups with regard to X-ray or Echocardiographic variables. The mean outflow cannula angle in the stroke group was 61.19 degrees, whereas that in the non-stroke cohort was 45.92 degrees. The mean diameter of outflow cannula anastomosis in the stroke group was 1.52 cm whereas that in the non-stroke group was 1.34 cm. CONCLUSION: Our study was the first to show that LVAD outflow cannula angle and diameter of anastomosis are significantly associated with stroke risk. Therefore, optimization of surgical technique/ engineering methods may help mitigate stroke risk in LVAD patients.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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