AI Article Synopsis
- The study focuses on managing spontaneous intracranial hemorrhage (ICH) in patients with mechanical heart devices like total artificial hearts (TAH) and left ventricular assist devices (LVAD).
- It highlights the challenges ICH presents due to anticoagulation and coagulopathy associated with these devices, emphasizing the need for prompt treatment involving both neurosurgeons and cardiac critical care teams.
- The research reviewed data from 2013-2016, revealing a high mortality rate and proposing a new multidisciplinary treatment algorithm to improve outcomes for affected patients.
Article Abstract
Background: Spontaneous intracranial hemorrhage (ICH) is frequently managed in neurosurgery. Patients with durable mechanical circulatory support devices, including total artificial heart (TAH) and left ventricular assist device (LVAD), are often encountered in the setting of ICH. Although durable mechanical circulatory support devices have improved survival and quality of life for patients with advanced heart failure, ICH is one of the most feared complications following LVAD and TAH implantation. Owing to anticoagulation and clinically relevant acquired coagulopathies, ICH should be treated promptly by neurosurgeons and cardiac critical care providers. We provide an analysis of ICH in patients with mechanical circulatory support and propose a treatment algorithm.
Methods: We retrospectively reviewed medical records from 2013-2016 for patients with a durable mechanical circulatory device at Banner-University of Arizona Medical Center Tucson. All patients with suspected ICH underwent computed tomography scan of the brain. Anticoagulation was managed by the cardiothoracic surgeon.
Results: In 58 patients, an LVAD (n = 49), TAH (n = 10), or both (n = 1) were implanted. Both acquired von Willebrand disease and spontaneous ICH were diagnosed in 5 patients (8.6%) who underwent LVAD implantation. Seven neurosurgical procedures were performed in 2 patients. The overall mortality rate was 60%. Two patients had little or no deficits after treatment with modified Rankin Scale score of 1 and 2, respectively.
Conclusions: We propose a novel treatment algorithm to manage patients with a LVAD or TAH and ICH, implemented in a multidisciplinary manner to best avoid neurologic and cardiovascular complications.
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| http://dx.doi.org/10.1016/j.wneu.2017.09.083 | DOI Listing |
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