Neurologic complications of the novacor left ventricular assist device

Background. The left ventricular assist device (LVAD) is a bridging mechani sm for patients with severe heart failure to remain viable until heart tran splantation. The rate of cerebral embolism has been reported as high as 47% in some studies but the rate of other neurologic complications in patients with LVADs is not known. Methods. Retrospective chart review of all patients who had LVADs implanted at our hospital from September 1993 until September 1997. Complications fr om the time of implantation until heart transplantation or death and functi onal outcome were assessed. Results. Twenty-three patients had LVADs placed in the four-year period. Of 23 patients, 9 had neurologic complications after placement of the LVAD. T hese included four strokes, three seizures, and two cases of delirium. The 3 patients with seizures all died from multiorgan failure. All of the patie nts with strokes received a transplant. One patient with delirium died from multiorgan failure and another received a transplant. The most devastating medical complication was renal failure, which occurred in 7 patients and w as associated with 100% mortality. All surviving patients with neurologic c omplications went on to transplant and good functional outcome. Conclusions. Neurologic complications are common in patients with LVADs, oc curring in 9 out of 23 patients in our series. Seizures are a poor prognost ic indicator and were associated with 100% mortality. Strokes did not have a negative impact on outcome. Patients with delirium had a mixed outcome, w hich reflects the multifactorial nature of delirium. Further study needs to be done to limit the neurologic complications associated with LVADs and fu rther improve outcomes. (C) 2001 by The Society of Thoracic Surgeons.