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Gastrointestinal bleeding with continuous-flow left ventricular assist devices

Syed Amer1, Parth Shah, Syed Hassan

  • 1Mayo Clinic, Phoenix, AZ, 85054, USA, docusa85@gmail.com.

Clinical Journal of Gastroenterology
|January 24, 2015
PubMed

Insights

Patients with continuous-flow left ventricular assist devices (CF-LVADs) face a high risk of gastrointestinal bleeding (GIB). This review details the unique pathophysiology, management, and prevention of GIB in CF-LVAD patients.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Medical Devices

Background:

  • Continuous-flow left ventricular assist devices (CF-LVADs) are vital for advanced heart failure.
  • Patients with CF-LVADs exhibit a significantly increased risk of gastrointestinal bleeding (GIB).
  • GIB lesions are observed throughout the GI tract, with a higher prevalence in the upper regions.

Purpose of the Study:

  • To comprehensively review the pathophysiology of GIB in CF-LVAD patients.
  • To outline current management strategies for GIB in this population.
  • To discuss complications and preventive measures for GIB in CF-LVAD recipients.

Main Methods:

  • Literature review focusing on GIB in CF-LVAD patients.
  • Analysis of the unique pathophysiological mechanisms contributing to GIB.
  • Synthesis of management and prevention strategies based on existing evidence.

Main Results:

  • GIB pathophysiology in CF-LVAD patients involves coagulopathy, acquired von Willebrand disease, and non-pulsatile flow.
  • Management approaches are tailored to bleeding site and clinical presentation.
  • Preventive strategies include optimizing pump speed, hemodynamic monitoring, and early endoscopy.

Conclusions:

  • Understanding the multifactorial pathophysiology of GIB is crucial for effective management.
  • Proactive prevention strategies are essential to reduce GIB incidence and severity in CF-LVAD patients.
  • Further research may refine therapeutic and preventive interventions for GIB in this high-risk group.

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