Carotid Artery Blood Flow and Its Association with Stroke During Left Ventricular Assist Device Support

Purpose Left ventricular assist device (LVAD) surgery is a life-prolonging therapy for advanced heart failure (HF). Despite many improvements over the years, LVADs continue to be associated with a high incidence of stroke and other vascular complications such as gastrointestinal bleeding (GIB). At present, the pathogenesis of these complications during LVAD support remains unclear. Abnormal structure and hemodynamics in large arteries are a potential contributor. We hypothesized that structural abnormalities and flow alterations will be significantly associated with stroke and a composite outcome of stroke, GIB, and death in HF patients before and during LVAD support. Methods We conducted a retrospective analysis of 141 carotid duplex studies in adult patients who received the HeartMate II LVAD. Clinical Doppler exams were evaluated before and after LVAD implantation. Parameters evaluated included peak-systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), pulsatility index (PI), ICA/CCA PSV ratio, plaque burden, and ICA stenosis. In addition, we noted demographics, outcomes, and LVAD speed parameters. Results Compared with HF patients, LVAD patients had decreased PSV (CCA: 80 vs. 50 cm/s, ICA: 72 vs. 56 cm/s; both P Conclusion We conclude that structural arterial disease in HF patients, namely carotid artery stenosis and plaque as evidenced by Doppler evaluation, was associated with stroke, GIB, and death during LVAD support while arterial flow parameters were not. Flow parameters during LVAD support were likewise unrelated to adverse events. Our findings support routine carotid duplex evaluation for clinical outcome prediction and encourage further study of the unique vascular physiology resulting from LVAD support.