Presence of Left Atrial or Left Ventricular Thrombus at the Time of CF-LVAD Implantation is Associated with Increased Post-Operative Risk of Stroke or Death.

Purpose Patients with advanced HF are at increased risk for intra-cardiac thrombus formation. The impact of pre-existing left atrial (LA) or left ventricular (LV) thrombi on post-operative outcomes in LVAD patients is unknown. Methods We retrospectively reviewed 376 patients who underwent HeartMate II LVAD implantation from February 2009 through August 2018 at a single large volume center. Transthoracic echocardiography (TTE) within 1 month of implant, intra-operative transesophageal echocardiography (TEE), and operative reports were reviewed to identify patients with pre-existing LA (including appendage) or LV thrombus at the time of LVAD implantation. We assessed the composite endpoint of stroke and death at 6 months and 2 years. Results Of the 376 patients (age 57±13 years, 81% male, 47% ICM), 26 (6.9%) had a pre-existing thrombus (13 in LA and 15 in LV). Incidence of stroke at 6 months was 23% in patients with intracardiac thrombi and 9% in patients without intracardiac thrombi (p=0.02). Incidence of stroke at 2 years was 23% in patients with intracardiac thrombi and 14% in patients without intracardiac thrombi (p=0.22). Notably all strokes occurred in the first 6 months of device support in patients with intra-cardiac thrombi. Patients were significantly more likely to die or have a stroke in the first 6 months of device support if they had pre-existing intracardiac thrombi (HR (95%CI): 2.7 (1.4, 5.2), p<0.01) (Figure). This finding held true at 2 yr (HR (95%CI): 2.0 (1.1, 3.6), p=0.01). There was no difference in stroke incidence between patients with LV vs LA thrombus. It is the practice at our institution to perform thrombectomy when feasible if significant clot is identified at the time of device implantation. Conclusion Pre-existing LA or LV thrombus is associated with decreased survival free of stroke following CF-LVAD implantation which may have important implications for patient selection and management. [ABSTRACT FROM AUTHOR]