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Background There is increasing recognition that the risk of stroke after left ventricular assist device (LVAD) implantation varies based on gender, with a higher risk in female patients. We reviewed our own data to determine gender differences in the risk of stroke. Methods Frequency of stroke, including intracranial hemorrhage and ischemic stroke, was retrospectively evaluated in 110 heart failure patients (mean age 49.6 ± 13.6 years, 32% women) discharged from the hospital after implantation of a HeartMate II ( N = 74) or HeartWare ( N = 36) LVAD. Competing outcomes analysis was used to determine which clinical risk factors were associated with the risk of stroke and death, with the primary end-point being time to first stroke event. Results During a median follow-up of 1.3 years, 26 patients had a stroke (23.6%, 0.14 case per person-year). The median time to first stroke was 0.7 (interquartile range 0.3 to 1.4) years. After adjusting for covariates, risk of stroke was higher for women than for men (hazard ratio 3.1, 95% confidence interval 1.4 to 6.9; p = 0.007). There was no difference in overall survival between men and women. Conclusion The risk of stroke after LVAD varies based on gender, with a higher risk in female patients. More research is needed to fully understand these differences, and whether device management strategies should be tailored based on gender.

Purpose Clinical scores for right ventricular failure (RVF) risk after left ventricular assist device implantation (LVAD) were developed in mostly pulsatile-flow LVAD populations, whereas most patients currently receive continuous-flow LVADs. Methods and Materials We evaluated the Michigan, Penn, and Utah scores and multiple pre-operative echocardiographic parameters for 90-day RVF prediction in 69 patients who underwent HeartMate-II (N=58) or HeartWare (N=11) implantation in 2007-2011. Results Baseline characteristics are presented in Table 1 . Overall 18 patients (26.1%) experienced RVF (defined as ≥48h NO use; multi-organ failure due to RVF; inotropes for ≥14 days post-LVAD; or re-institution of inotropes). Among clinical scores, only Michigan predicted RVF (OR per point: 1.29; 95% CI: 1.04, 1.59; P=0.02) but discrimination was modest (C=0.64, P=0.093; sensitivity: 50%; specificity: 78.4%). Penn (C=0.50; P=0.99) and Utah (C=0.52; P=0.78) scores did not discriminate RVF. Among echocardiographic parameters, only a smaller left atrial diameter (OR per -10 mm: 2.36; 95% CI: 1.01, 5.45; P=0.045) was associated with RVF and, when added to, improved discrimination of Michigan score to C=0.76 (P Conclusions RVF risk prediction scores developed for pulsatile LVADs are suboptimal for patients with continuous-flow LVADs. Baseline clinical and echocardiographic characteristics (N=69) Patients with RVF (N=18) Patients without RVF (N=51) P Age, yrs 55.2±9.4 48.9±13.9 0.078 Male, % 61.1 47.1 0.56 Ischemic HF, % 27.8 29.4 1.00 Intra-aortic balloon pump pre-op, % 38.9 25.5 0.37 Inotropes pre-op, % 100 96.1 1.00 Pressors pre-op, % 11.1 5.9 0.60 Bilirubin, mg/dL 1.6±0.9 1.6±1.1 0.77 AST, U/L 58 (35, 127) 30 (23, 39) 0.002 Creatinine, mg/dL 2.0±0.7 1.6±1.0 0.014 Cardiac index, L/m 2 1.75±0.50 1.75±0.43 0.86 RV stroke work index, mmHg a l/min 0.52±0.26 0.49±0.24 0.50 LV ejection fraction, % 18.8±4.8 19.1±5.1 0.54 Left atrial diameter, mm 47±6 52±8 0.034 RV fractional area change, % 30.0±6.0 27.8±8.0 0.14