Sex-related Incidence of Stroke After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis

Abstract

Background: With the widespread application of left ventricular assist devices (LVADs), post-LVAD implantation stroke has become one of the most serious complications. However, little is known about sex differences in stroke occurrence after LVAD implantation.

Methods: Multiple databases were searched to identify studies on the prevalence of post-LVAD stroke stratified by sex. A meta-analysis was employed to synthesize the sex differences in both relative and absolute risks of post-LVAD stroke. Subgroup and meta-regression analyses were used to compare the sex differences in stroke risk among different regions, average ages, and publication years.

Results: Twenty-eight studies involving 47,125 adult patients with LVADs were included. Overall, among LVAD patients, the relative risk (RR) of stroke in females was 1.12 times higher than in males (RR = 1.12, 95% confidence interval [CI] 1.04-1.21). Subgroup analysis revealed that the RR of stroke after LVAD in Asian females was 1.40 times that of males (RR = 1.40, 95% CI 1.11-1.76), and the RR of stroke after LVAD in North American females was 1.25 times that of males (RR = 1.25, 95% CI 1.07-1.46). Meta-regression analysis showed no significant relationship between RR and the average age (p = 0.469) or the publication year (p = 0.096).

Conclusion: Females demonstrate a significantly greater likelihood of experiencing post-LVAD stroke than males, especially in Asians. Future research should explore the sex differences in stroke after LVAD implantation, considering various confounding factors, to achieve sex-inclusive individualized treatment.

Keywords: complication; left ventricular assist device; meta-analysis; sex differences; stroke.