gms | German Medical Science

Objective: Implantable pulsatile ventricular assist devices have proven to be successful to bridge time to transplantation in patients with therapy resistant heart failure. In the Department of Cardiothoracic, Transplantation and Vascular Surgery more than 280 cardiac ventricular assist devices have been implanted since January 2005. Anticoagulation is the prerequisite condition. Frequently coumarin derivatives are used. The frequency and outcome of cerebral hemorrhage in these patients is unknown.

Method: All patients with intracranial hemorrhage who had a cardiac ventricular assist device between January 2005 and November 2012 were evaluated retrospectively. Special attention was paid to timing of treatment and outcome. All patients underwent craniotomy and coagulation was normalized.

Results: Between January 2005 and November 2012 cardiac ventricular assist devices were implanted in 281 (236 male, 45 female) patients with heart failure in the Department of Cardiothoracic, Transplantation and Vascular Surgery. Age ranged between 0 years to 77 years. In this period seven patients (2.5%, all male) sustained an intracranial hemorrhage, which was removed via craniotomy or burrhole. Intracerebral hemorrhage was found in five patients (1.8%) and was located in the cerebrum (2 left frontal, 1 intraventricular, 1 right frontal, 1 left parietal). Two patients (0.7%) suffered from subdural hematoma, one acute and one chronic subdural hematoma. Four (1.4%) of seven patients (2.5%) died. One patient received a donor heart, one patient lives in minimal conscious state and one patient is still waiting for heart transplantation and lives with assist device.

Conclusions: Intracranial hemorrhage is a relatively rare complication in patients with cardiac ventricular assist devices and anticoagulation. Intracranial hemorrhage in these patients is associated with high mortality.