Gastrointestinal Bleeding With Left Ventricular Assist Devices (LVAD): Locating the Leak and Identifying Outcomes. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Malik, Sarah; Malik, Shahbaz A.; Ulmer, Laura L.; Jha, Lokesh K.; Strupp, Michael S.; Raichlin, Eugenia; Lyden, Elizabeth R.; Hewlett, Alexander T.
• Is Part Of: Journal of clinical gastroenterology. Volume 53:Issue 5(2019)
• Publication Date: 2019-05
• Subjects: gastrointestinal bleeding -- left ventricular assist device -- outcome research; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Digestive organs -- Diseases; Gastroenterology; Periodicals; Periodicals; 616.33005
• DOI: 10.1097/MCG.0000000000001041
• Languages: English
• ISSNs: 0192-0790

Abstract

Abstract : Background and Goals: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. Study: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups. Results: Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P =0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P =0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P =0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P =0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P ⩽0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P =0.01) and the mortality rate during hospitalization for GIB was 11% ( P =0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P =0.016). Conclusions: Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.