Heart failure predisposes to intracardiac thrombus (ICT) formation. There is limited data on prevalence and impact of pre-existing ICT on postoperative outcomes in LVAD patients. We examined the risk for stroke and death in this patient population.

We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between 2/2009 and 3/2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT.

525 LVAD patients (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) were included. An ICT was identified in 44 (8.4%) patients. During the follow up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.00–3.33, p=0.049). Patients with ICT were also at higher risk for stroke (HR: 2.45, 95% CI: 1.14–5.28, p=0.021) and death (HR: 2.36, 95% CI: 1.17–4.79 p=0.016) at 6 months follow up.

Presence of ICT is an independent predictor of stroke and death at 6-month after LVAD. Additional studies are needed to help risk stratify and optimize perioperative management of this patient population.