Neurological Dysfunction Associated With Mechanical Circulatory Support: Complications That Still Need Attention

摘要

... fewer than half of the patients in the LVAD group had a neurological event .. .Lazar et al., Circulation 2004;109:2423-7(l)While infection and bleeding are clearly the most prevalent complications in mechanical circulatory support, neurological complications can perhaps be the most devastating. These complications are a leading cause of morbidity, mortality, increased hospital stay, and cost. These complications impact not only the patient, but also the entire health-care delivery team, and the patient's friends and family.While a certain baseline level of neurological complications including cerebrovascular accidents (CVAs), transient ischemic attacks (TIAs), or other neurologic deficits can be reasonably expected in the extremely moribund patient population receiving mechanical circulatory support, it is still unclear what this baseline level should be. Perhaps the most valuable insight in this area came from the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive HeartFailure (REMATCH) study, which through randomization of the control group to optimal medical management delineated the impact of mechanical circulatory support on neurological events as highlighted in Table 1.