• Paul Yen, Terri Sun, Jaycee Farmer, Laura Besola, Anson Cheung, Defen Peng, Wynne Chiu, Jamil Bashir, Dean Johnston, Thalia Field, and Alana Flexman.
• Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada. Electronic address: paul.ph.yen@alumni.ubc.ca.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 26.

ObjectivesStroke is common following left ventricular assist device (LVAD) implantation, although comprehensive data on perioperative strokes in this uncommon population is lacking. The current study aim was to characterize the presentation, features, and outcomes of perioperative cerebrovascular ischemia post-LVAD implantation at the authors' institution.DesignSingle-center retrospective cohort.SettingSt. Paul's Hospital, Vancouver, British Columbia, Canada.ParticipantsAdult patients who received an LVAD between January 1, 2008, and August 31, 2021, were included, and those who died intraoperatively or underwent a concurrent cardiac surgical procedure were excluded.InterventionsData on demographics, comorbidities, stroke risk factors and characteristics, management, and outcomes (transplant, explant, death with LVAD in situ) were extracted.Measurements And Main ResultsAfter exclusions, 172 adult patients who underwent LVAD implantation during the study period were included and analyzed. The rate of perioperative stroke was 12.8% (22/172). Of these, 72.7% (16/22) had a stroke occur within 7 days of surgery, and 86.4% (19/22) had a primarily ischemic (v hemorrhagic) event. A total of 68.2% (15/22) were intubated, sedated, or recently extubated at symptom onset, complicating diagnosis. All were managed supportively or palliated without specific stroke intervention. Patients who experienced a perioperative stroke had a significantly lower cumulative incidence of survival to cardiac transplantation and a significantly higher cumulative incidence of dying with their device in situ.ConclusionsLVAD patients carry a high risk of perioperative stroke. They experience delayed recognition and diagnosis, limited intervention, and poor outcomes. Frequent neurological assessment and a low threshold for neuroimaging are prudent.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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