To review neurologic complications that are associated with left ventricular assist devices (LVAD). 

We reviewed 472 consecutive patients who underwent HeartMate or HeartMate II implantation from October 2004 to December 2016. We defined focal neurologic complications as ischemic and hemorrhagic stroke, infective intracranial aneurysm (IIA), and seizures. Timing of ischemic stroke is divided into peri-operative and late. A peri-operative stroke is one that occurred within 14 days of LVAD implant. Seizures were diagnosed clinically or by EEG. 

We recorded cases of encephalopathy following LVAD implant separately. Encephalopathy was defined as confusion or disorientation and any subtype of delirium (hypoactive, hyperactive, or mixed). 

89 patients (16.4%) had at least one focal neurologic complication. 107 total focal neurologic complications were recorded. Fourteen patients had a peri-operative stroke, and there were 45 late ischemic strokes. 36 patients had at least one type of intracranial hemorrhage. We recorded 26 cases of intra-parenchymal hemorrhage, 15 of SAH, and 8 of SDH. Four patients had IIAs. Seventeen patients (3.3%) had new-onset seizures after LVAD implant, all provoked by a CNS insult.

Finally, encephalopathy was observed in 135 patients (28.6%) following LVAD implant during their index admission. Median duration of encephalopathy was five days (IQR 5.3). Hyperactive delirium was the most common presentation at 54.8% (n=74). Other manifestations were confusion or disorientation (n=35), mixed delirium (n=20), followed by hypoactive delirium (n=7).

Clinicians should be mindful of the full spectrum of neurologic complications associated with LVAD. These complications have major implications on inpatient mortality, post-operative recovery, and long-term cognitive function.