Subacute gastric perforation caused by a left ventricular assist device

Area of Science:

• Cardiology
• Gastroenterology
• Medical Device Complications

Background:

• Left ventricular assist devices (LVADs) are crucial for managing end-stage heart failure.
• Ischemic cardiomyopathy following myocardial infarction can necessitate LVAD implantation.
• Intractable congestive heart failure remains a significant challenge in cardiac care.

Observation:

• A patient with ischemic cardiomyopathy developed chronic bacteremia and recurrent septic episodes post-LVAD implantation.
• Gastric endoscopy revealed a rare complication: perforation of the anterior stomach wall by the LVAD.
• Erosions on the LVAD's metallic surface suggested prolonged exposure to gastric acid.

Findings:

• This report documents the second known case of LVAD-induced gastric perforation.
• It is the first reported case of this complication presenting with a subacute clinical course.
• The findings highlight a potentially underrecognized gastrointestinal complication of LVAD therapy.

Implications:

• Awareness of this rare LVAD complication is crucial for timely diagnosis and management.
• Further investigation into the mechanisms and prevention of LVAD-related gastrointestinal injury is warranted.
• This case underscores the importance of multidisciplinary collaboration in managing complex cardiac device patients.