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Multicenter Analysis of Outcomes in Non-Trial versus Trial-Like Patients with Commercial Heartmate 3 LVAD. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Comparison of Heart Failure Therapy Implementation in Patients with and without Temporary Right Ventricular Assist Device Following HeartMate 3 LVAD Implantation: A 6-Month Post-Implant Comparison. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Effective Transition from Continuous Parenteral Treprostinil to Oral Prostacyclin Pathway-Based Therapies in Pulmonary Arterial Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Biventricular Heartmate 3s as a Bridge-To-Candidacy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Outcomes in Patients with Commercial HeartMate 3 LVAD: A Comparative Analysis of Non-Trial versus Trial Like Cohorts. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Adverse Events of Temporary Extracorporeal Right Ventricular Assist Devices Placed with Durable Left Ventricular Assist Devices. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Does Hemodynamic Response to Inotropes Predict Early Right Heart Failure After LVAD Implantation? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Improved Hemodynamic Response Following Intra-Aortic Balloon Pump Support in Patients with Heart Failure Related Cardiogenic Shock and Severe Right Ventricle Dysfunction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Predictive Accuracy of Hemodynamic Surrogate Indices in Patients with Advanced Heart Failure. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cerebrovascular accidents in patients supported with veno-arterial extra-corporeal membrane oxygenation- is duration of support important? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose of study
Veno-Arterial Extra-corporeal Membrane Oxygenation (VA-ECMO) is indicated for refractory cardiac and/or respiratory failure. Adverse events remain considerable despite best practices. We specifically aimed to understand risk factors associated with cerebrovascular accidents (CVA) in patients who underwent VA-ECMO support.
Methods
We retrospectively assessed all VA-ECMO patients from 2007 to 2019 at our institution. We identified those who experienced a CVA while supported by VA-ECMO. Patients with the primary event (CVA) were matched to controls (no CVA) based on age and sex. Comparisons were made between groups using McNemar's, Mantel-Haenszel, and Wilcoxon Signed-Rank tests where appropriate.
Results
Of the 278 VA-ECMO patients in the registry, 32 patients who experienced a CVA were identified; 24 (8.6%) ischemic and 8 (2.9%) hemorrhagic. Median age was 59.5 years (inter-quartile range: 49–65 years) and 75% of patients were males. Hypertension, diabetes, CAD and CHF were common co-morbidities (Table 1). Cardiogenic shock was the most common indication for VA-ECMO support in both cohorts, 75% in cases and 71.9% in controls. Cannulation strategies were identified as central or peripheral. There was a significant association of duration of VA-ECMO support with incidence of CVA, with a p-value of 0.03. Regression analysis showed a trend of increased risk of CVA by 4% for each additional day on VA-ECMO, however, this was not statistically significant (Odds ratio: 1.04; confidence interval 1.00–1.08). Most common outcome was death followed by decannulation to recovery and bridge to LVAD.
Conclusion
Ischemic and hemorrhagic CVAs are not uncommon during VA-ECMO support. Our case control study shows an association of duration of VA-ECMO support with incidence of CVA. This underscores the importance of timely assessment and weaning or bridging of VA-ECMO patients to their next management step.
Funding Acknowledgement
Type of funding sources: None.
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Low Flow Alarms! A Case of Percutaneous LVAD Decommissioning. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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1,2,3: Use of Ang II in a HM3. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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The Association of BMI and Diabetes Mellitus with Mortality in End Stage Heart Failure Patients on Inotropes. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Outcomes of Pre- Heart Transplantation Desensitization in Highly Sensitized Patients Bridged with Left Ventricular Assist Devices. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Home Inotropic Therapy Post Left Ventricular Assist Device Placement. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Outcomes of Heart Transplant Recipients with LVAD Implantation as Destination Therapy versus Bridge to Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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6 Are Blood Stream Infections Associated with Increased Risk of Stroke in Patients with a Continuous Flow Left Ventricular Assist Device? J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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499: Is screening computed tomography of the chest, abdomen, and pelvis in potential heart transplant recipients necessary? J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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