{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T03:25:13Z","timestamp":1785209113050,"version":"3.55.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Stroke is a severe complication in patients with left ventricular assist devices (LVAD), significantly affecting quality of life and potentially leading to death. This study aimed to illustrate the clinical features, outcomes, and risk factors associated with stroke in LVAD patients, with the goal of identifying potential treatment targets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a study of 249 consecutive patients who underwent LVAD implantation, detailed evaluations were conducted regarding clinical characteristics, perioperative management, cardiovascular risk factors, comorbidities, and brain imaging. The etiology, treatment, and outcomes were subsequently assessed in individuals who encountered a stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty-three cerebrovascular events (CVE) occurred in 54\/249 patients during a median study period of 2.2 years (0.4\u20133.5) with 53 ischemic events and 22 intracranial hemorrhages (ICH). Early peri- or postoperatively CVE in context to the LVAD implantation were identified in 31 patients. Competing risks regression analysis revealed that postoperative dialysis was associated with higher risk for CVE, considering death as competing risk event (HR 3.617; 95%-CI: 1.78\u20137.35; <jats:italic>p<\/jats:italic>\u2009\u2264\u20090.001). Modified Rankin Scale at outpatient visit did not differ in early CVE [3 (IQR 2\u20135) vs. 3 (IQR2\u20134), <jats:italic>p<\/jats:italic>\u2009=\u20090.146]. Late CVE frequently occurred during hospitalization for sepsis or in cardiac rehabilitation [<jats:italic>n<\/jats:italic>\u2009=\u200916\/41 events (39%)]. Competing risk analysis treating death and heart transplantation as competitors identified history of stroke as associated factor [HR 3.564; 95%-CI (1.67\u20137.169); <jats:italic>p<\/jats:italic>\u2009=\u20090.001]. Mortality was not associated with CVE [with <jats:italic>n<\/jats:italic>\u2009=\u200927\/54 (50%) vs. without CVE 94\/195 (48.2%) <jats:italic>p<\/jats:italic>\u2009=\u20090.183].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients who require postoperative dialysis face a heightened risk for early cerebrovascular events (CVE) during and after LVAD implantation. Additionally, a history of stroke and complicated clinical courses should increase awareness regarding the potential for impending CVE in the long term.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1591208","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T05:44:49Z","timestamp":1757396689000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Stroke in patients with left ventricular assist device (LVAD): who is at risk?\u2014a retrospective observational study at a tertiary care center"],"prefix":"10.3389","volume":"12","author":[{"given":"Yasemin","family":"Akalan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Worthmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Berliner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Hupe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerrit M.","family":"Grosse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Abu-Fares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim K.","family":"Ravenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Weissenborn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjang","family":"Ruhparwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Talbot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan D.","family":"Schmitto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin S.","family":"Hanke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M.","family":"Gabriel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.25646\/8459","article-title":"Health situation of adults in Germany\u2014results for selected indicators from GEDA 2019\/2020-EHIS","volume":"6","author":"Heidemann","year":"2021","journal-title":"J Health Monit"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"B3","article-title":"DSO Jahresbericht","year":"2021"},{"key":"B4","first-page":"1","article-title":"Left ventricular assist devices: an evidence-based analysis","volume":"4","year":"2004","journal-title":"Ont Health Technol Assess Ser"},{"key":"B5","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1016\/j.athoracsur.2020.12.038","article-title":"The society of thoracic surgeons intermacs 2020 annual report","volume":"111","author":"Molina","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1016\/j.healun.2017.07.005","article-title":"Eighth annual INTERMACS report: special focus on framing the impact of adverse events","volume":"36","author":"Kirklin","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"B7","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1111\/jocs.14079","article-title":"Stroke after implantation of continuous flow left ventricular assist devices","volume":"34","author":"Tsiouris","year":"2019","journal-title":"J Card Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/B978-0-7020-4088-7.00082-1","article-title":"Neurologic aspects of heart transplantation","volume":"121","author":"Heroux","year":"2014","journal-title":"Handb Clin Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"00531","DOI":"10.1053\/j.jvca.2024.08.016","article-title":"Heartmate 3: analysis of outcomes and future directions","author":"Ripoll","year":"2024","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1093\/ejcts\/ezab018","article-title":"Five-year outcomes of patients supported with HeartMate 3: a single-centre experience","volume":"59","author":"Schmitto","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.cjca.2022.11.004","article-title":"Neurologic complications in patients with left ventricular assist devices","volume":"39","author":"Shoskes","year":"2023","journal-title":"Can J Cardiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1161\/STROKEAHA.118.022967","article-title":"Stroke incidence and impact of continuous-flow left ventricular assist devices on cerebrovascular physiology","volume":"50","author":"Cornwell","year":"2019","journal-title":"Stroke"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1001\/jama.2022.16197","article-title":"Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial","volume":"328","author":"Mehra","year":"2022","journal-title":"JAMA"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1056\/NEJMoa1900486","article-title":"A fully magnetically levitated left ventricular assist device\u2014final report","volume":"380","author":"Mehra","year":"2019","journal-title":"N Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.healun.2020.01.1337","article-title":"This is your brain on LVAD","volume":"39","author":"Frontera","year":"2020","journal-title":"J Heart Lung Transplant"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1002\/ejhf.2526","article-title":"Improved survival of left ventricular assist device carriers in Europe according to implantation eras: results from the PCHF-VAD registry","volume":"24","author":"Jakus","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"B17","doi-asserted-by":"publisher","first-page":"622","DOI":"10.5301\/ijao.5000628","article-title":"Long-term follow-up of continuous flow left ventricular assist devices: complications and predisposing risk factors","volume":"40","author":"Adesiyun","year":"2017","journal-title":"Int J Artif Organs"},{"key":"B18","doi-asserted-by":"publisher","first-page":"42","DOI":"10.3389\/fsurg.2015.00042","article-title":"Late complications following continuous-flow left ventricular assist device implantation","volume":"2","author":"Grimm","year":"2015","journal-title":"Front Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1056\/NEJMoa1800866","article-title":"Two-year outcomes with a magnetically levitated cardiac pump in heart failure","volume":"378","author":"Mehra","year":"2018","journal-title":"N Engl J Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1111\/aor.14165","article-title":"Inflow cannula position as risk factor for stroke in patients with HeartMate 3 left ventricular assist devices","volume":"46","author":"Schl\u00f6glhofer","year":"2022","journal-title":"Artif Organs"},{"key":"B21","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/s10047-018-1034-5","article-title":"Blood stream infection is associated with cerebrovascular accident in patients with left ventricular assist device: a systematic review and meta-analysis","volume":"21","author":"Kanjanahattakij","year":"2018","journal-title":"J Artif Organs"},{"key":"B22","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.healun.2021.07.011","article-title":"Long-term survival on LVAD support: device complications and end-organ dysfunction limit long-term success","volume":"41","author":"Hariri","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1016\/j.healun.2017.05.008","article-title":"Bleeding and thrombosis associated with ventricular assist device therapy","volume":"36","author":"Shah","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"B24","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1111\/aor.14409","article-title":"Microembolic signal monitoring in patients with HeartMate 3 and HeartWare left ventricular assist devices: association with antithrombotic treatment and cerebrovascular events","volume":"47","author":"Ravenberg","year":"2023","journal-title":"Artif Organs"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e003032","DOI":"10.1161\/CIRCHEARTFAILURE.116.003032","article-title":"INTERMACS (Interagency registry for mechanically assisted circulatory support) profiling identifies ambulatory patients at high risk on medical therapy after hospitalizations for heart failure","volume":"9","author":"Stewart","year":"2016","journal-title":"Circ Heart Fail"},{"key":"B26","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1093\/europace\/euaa358","article-title":"The interpretation of CHA2DS2-VASc score components in clinical practice: a joint survey by the European Heart Rhythm Association (EHRA) scientific initiatives committee, the EHRA young electrophysiologists, the association of cardiovascular nursing and allied professionals, and the European Society of Cardiology council on stroke","volume":"23","author":"Zhang","year":"2021","journal-title":"Europace"},{"key":"B27","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1055\/a-1783-7212","article-title":"Die neue internationale sepsis-leitlinie der surviving sepsis campaign 2021","volume":"57","author":"Palmowski","year":"2022","journal-title":"Anasthesiol Intensivmed Notfallmed Schmerzther"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3393","DOI":"10.1161\/STROKEAHA.109.557256","article-title":"Reliability of the modified rankin scale: a systematic review","volume":"40","author":"Quinn","year":"2009","journal-title":"Stroke"},{"key":"B29","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1097\/MAT.0000000000000901","article-title":"What causes LVAD-associated ischemic stroke? Surgery, pump thrombosis, antithrombotics, and infection","volume":"65","author":"Cho","year":"2019","journal-title":"ASAIO J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/j.healun.2016.12.010","article-title":"Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices","volume":"36","author":"Frontera","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"B31","volume-title":"cmprsk: Subdistribution Analysis of Competing Risks","author":"Gray","year":"2024"},{"key":"B32","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-24277-4","volume-title":"ggplot2: Elegant Graphics for Data Analysis","author":"Wickham","year":"2016"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1159\/000517454","article-title":"Stroke in patients with left ventricular assist devices","volume":"51","author":"Plecash","year":"2022","journal-title":"Cerebrovasc Dis"},{"key":"B34","doi-asserted-by":"publisher","first-page":"105166","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105166","article-title":"Management of stroke in patients with left ventricular assist devices","volume":"29","author":"Giede-Jeppe","year":"2020","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B35","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1097\/HCO.0000000000000284","article-title":"Bleeding and thrombosis in chronic ventricular assist device therapy: focus on platelets","volume":"31","author":"Koliopoulou","year":"2016","journal-title":"Curr Opin Cardiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"3038","DOI":"10.1161\/CIRCULATIONAHA.111.040246","article-title":"Bleeding and thrombosis in patients with continuous-flow ventricular assist devices","volume":"125","author":"Eckman","year":"2012","journal-title":"Circulation"},{"key":"B37","doi-asserted-by":"publisher","first-page":"3264","DOI":"10.1007\/s12325-024-02913-x","article-title":"Clinical outcomes in patients with CKD and rapid or non-rapid eGFR decline: a report from the DISCOVER CKD retrospective cohort","volume":"41","author":"Heerspink","year":"2024","journal-title":"Adv Ther"},{"key":"B38","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1159\/000356086","article-title":"Stroke in dialysis and chronic kidney disease","volume":"36","author":"Power","year":"2013","journal-title":"Blood Purif"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1053\/j.ajkd.2005.02.028","article-title":"Stroke in patients on maintenance hemodialysis: a 22-year single-center study","volume":"45","author":"Toyoda","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.1016\/j.cardfail.2022.03.355","article-title":"Outcomes in patients with chronic kidney disease and end-stage renal disease and durable left ventricular assist device: insights from the United States renal data system database","volume":"28","author":"Dalia","year":"2022","journal-title":"J Card Fail"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e24227","DOI":"10.7759\/cureus.24227","article-title":"Outcomes with left ventricular assist device in end-stage renal disease: a systematic review","volume":"14","author":"Lakhdar","year":"2022","journal-title":"Cureus"},{"key":"B42","doi-asserted-by":"publisher","first-page":"102564","DOI":"10.1016\/j.rpth.2024.102564","article-title":"Platelet reactivity is associated with pump thrombosis in patients with left ventricular assist devices","volume":"8","author":"Mutschlechner","year":"2024","journal-title":"Res Pract Thromb Haemost"},{"key":"B43","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1093\/icvts\/ivt546","article-title":"Close antiplatelet therapy monitoring and adjustment based upon thrombelastography may reduce late-onset bleeding in HeartMate II recipients","volume":"18","author":"Karimi","year":"2014","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B44","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1111\/jocs.13778","article-title":"Strokes associated with left ventricular assist devices","volume":"33","author":"Kislitsina","year":"2018","journal-title":"J Card Surg"},{"key":"B45","volume-title":"Urgent Medical Device Correction: HeartWare Ventricular Assist Device (HVAD) System","year":"2021"},{"key":"B46","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1161\/CIRCULATIONAHA.118.037231","article-title":"Comprehensive analysis of stroke in the long-term cohort of the MOMENTUM 3 study","volume":"139","author":"Colombo","year":"2019","journal-title":"Circulation"},{"key":"B47","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1001\/jama.2014.8165","article-title":"Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery","volume":"312","author":"J\u00f8rgensen","year":"2014","journal-title":"JAMA"},{"key":"B48","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.1016\/j.athoracsur.2013.07.004","article-title":"Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation","volume":"96","author":"Stulak","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"B49","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1001\/jama.2023.23204","article-title":"Aspirin and hemocompatibility events with a left ventricular assist device in advanced heart failure: the ARIES-HM3 randomized clinical trial","volume":"330","author":"Mehra","year":"2023","journal-title":"JAMA"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1016\/j.jacc.2009.02.048","article-title":"Severely impaired von willebrand factor-dependent platelet aggregation in patients with a continuous-flow left ventricular assist device (HeartMate II)","volume":"53","author":"Klovaite","year":"2009","journal-title":"J Am Coll Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1591208\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T05:44:54Z","timestamp":1757396694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1591208\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":50,"alternative-id":["10.3389\/fcvm.2025.1591208"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1591208","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]},"article-number":"1591208"}}