Incidence, presentation, and outcomes of intracranial hemorrhage in left ventricular assist device patients.

Objective: The objective was to evaluate the etiology, natural history, and impact of surgical intervention on outcomes of left ventricular assist device (LVAD) patients presenting with intracranial hemorrhage (ICH).

Methods: The authors completed a retrospective review of LVAD patients who presented with ICH at 2 centers between 2013 and 2022. Patients were reviewed for demographic, clinical, and radiographic variables. LVAD patients were followed for 9.5 years from implantation and 1 year after ICH. The primary outcome was 90-day functional independence defined as modified Rankin Scale (mRS) score 0-2. Secondary outcomes included mortality and rehemorrhage.

Results: Among 1339 LVAD patients, 111 (8.3%) had ICH (mean age 53 years and 65% male). ICH occurred within a median of 18 months from LVAD implantation. Neurosurgery was performed on 16 patients. The inpatient and 90-day mortality rates were 32% and 51%, respectively, which did not differ among hemorrhage types. The rate of functional independence at 90 days was 29%. Rehemorrhage occurred in 16% of patients. The median cost for inpatient hospitalization was $27,000. Predictors of mortality included admission Glasgow Coma Scale (GCS) score and presence of operative indication. Neurosurgery did not predict either functional independence or mortality after controlling for presenting variables.

Conclusions: ICH as a complication of LVAD placement is increasing in frequency. GCS score on presentation best predicted mortality at 90 days. Neurosurgical intervention did not impact outcomes in the authors' study, which warrants further investigation in prospective cohorts.