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Major bleeding during HeartMate II support.
Matthew C Bunte1, Eugene H Blackstone, Lucy Thuita
1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Journal of the American College of Cardiology
|September 3, 2013
Summary
Major bleeding complications after HeartMate II (HMII) left ventricular assist device implantation peak within 2 weeks post-surgery. Early bleeding events are linked to reduced survival, with thoracic and GI sources being most common.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
- Transplant Surgery
Background:
- Bleeding is the most frequent complication following HeartMate II (HMII) left ventricular assist device implantation.
- The temporal patterns and prognostic implications of bleeding events after HMII implantation are not fully understood.
Purpose of the Study:
- To characterize major bleeding complications in patients receiving HeartMate II (HMII) left ventricular assist device support.
- To investigate the subtypes and temporal patterns of post-operative bleeding events.
Main Methods:
- A retrospective analysis of 139 HeartMate II (HMII) recipients (145 devices) from October 2004 to June 2010.
- Major bleeding defined by Interagency Registry for Mechanically Assisted Circulatory Support criteria, with enhanced sensitivity.
- Multivariable analysis assessed pre-operative variables, coagulation status, and bleeding recurrence.
Main Results:
- The cumulative incidence of major bleeding was 58% over 171 patient-years.
- The rate of major bleeding was 1.14 events per patient-year, with 44% being recurrent.
- The highest risk of bleeding occurred within 2 weeks post-implantation; early bleeding correlated with reduced survival.
Conclusions:
- The risk of major bleeding after HeartMate II (HMII) implantation is highest in the early post-operative period.
- Thoracic and gastrointestinal bleeding are the predominant sources, though unexplained anemia requiring transfusion is also noted.
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