SINGLE CENTER EXPERIENCE REGARDING STROKE OUTCOMES FOLLOWING IMPLANTATION OF THE CARDIOWEST TOTAL ARTIFICIAL HEART

Background: Strokes (CVAs) are a serious complication following implantation of circulatory assist devices. To reduce the risk of CVA fallowing implantation of the CardioWest total artificial heart (CWTAH), we use multi-system monitoring (MSM) to individualize a multi-drug regimen (MDR) consisting of heparin with conversion to warfarin, aspirin, dipyridamole and pentoxifylline. This describes the CVA outcomes at the University of Arizona following implantation of the CWTAH. Methods: Patient (Pt) clinical data consisting of age, gender, duration of implant, and occurrence of CVA were prospectively entered into a dedicated computerized database and the results analyzed retrospectively. A CVA was defined as a prolonged (>24 hours) neurological deficit not present at baseline as determined by a standard neurological examination and confirmed by head CT scan. Results: Between September 30, 1994 and December 19, 2003, 63 Pts, 54 males (86%) and 9 females (14%), aged 15 to 67 years (yrs), were implanted with the CWTAH. The total, mean (± SD), median and range of implant days were 5497 (15.06 yrs), 87.25 ± 91.33, 58, and 1 to 413 days, respectively. A CVA occurred in one Pt at 11-weeks post-implant resulting in an annualized rate of 0.07 CVAs/Pt-yr. Conclusions: The use of MSM to individualize a MDR following implantation of the CWTAH results in a very low post-implant CVA rate over a wide range of Pt ages.