Impact of Stroke Onset Severity on 2-Year Survival in Destination Therapy Patients Supported by Centrifugal Flow versus Axial Flow Ventricular Assist Devices

Purpose The ENDURANCE Supplemental Trial (DT2) was designed to prospectively study whether improved blood pressure management would reduce the incidence of strokes in destination therapy patients receiving an HVAD. The trial not only demonstrated a significant reduction in hemorrhagic strokes, but also some reductions in stroke-related severity. This analysis seeks to study further the impact of stroke severity on 2-year survival in both the HVAD and control cohorts of DT2. Methods A retrospective analysis was performed on DT2 patients to identify those who experienced a stroke within 2 years of device implant. Strokes were defined as a focal neurological deficit with an associated finding on computed tomography. Modified Rankin Scale (mRS) was performed by a neurologist at presentation. MRS scores were labeled as Minor (mRS 0 - 3, non-disabling) or Major (mRS 4 - 6, disabling). Survival was calculated using Kaplan-Meier analysis. Time 0 was the date of a patient's first stroke post-implant. Results Of the 465 patients enrolled in DT2 (157 control, 308 HVAD), strokes within 2 years of implant were identified in 107 patients, 34 control (19 Minor, 15 Major), and 74 HVAD (46 Minor, 28 Major). The survival analysis following first stroke onset revealed a significant difference in survival rates (p Conclusion Analysis of post-stroke survival by severity in the ENDURANCE Supplemental Trial revealed better 2-year survival in patients with non-disabling versus disabling stroke. Conversely, survival rates within the control cohort appeared similar regardless of severity, although the sample size was small. HVAD patients with a non-disabling stroke appeared to have a higher 2-year survival rate compared to the control cohort.