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Gastrointestinal Bleeding during Continuous-Flow Left Ventricular Assist Device Support is Associated with Lower
Christopher T Holley1, Laura Harvey, Samit S Roy
1From the *Department of Surgery, University of Minnesota, Minneapolis, Minnesota; and †Department of Cardiology, University of Minnesota, Minneapolis, Minnesota.
Insights
Gastrointestinal bleeding after continuous-flow left ventricular assist device (CF-LVAD) implantation is common. This bleeding may decrease cardiac transplant rates in eligible patients, possibly due to increased blood transfusions.
Area of Science:
- Cardiology
- Gastroenterology
- Transplantation
Background:
- Gastrointestinal bleeding (GIB) is a frequent complication following continuous-flow left ventricular assist device (CF-LVAD) implantation.
- The impact of GIB on cardiac transplantation outcomes in CF-LVAD patients is not well understood.
Purpose of the Study:
- To identify risk factors for GIB in CF-LVAD patients.
- To evaluate the association between GIB and the rate of subsequent cardiac transplantation.
Main Methods:
- Retrospective review of 232 patients who received a HeartMate II CF-LVAD.
- Analysis of GIB episodes, transfusion rates, and cardiac transplantation outcomes.
- Statistical analysis to determine risk factors and transplant rates.
Main Results:
- The incidence of GIB was 27% (0.45 episodes/patient-year).
- Women represented a higher proportion of GIB cases (29%) compared to their cohort representation (15%).
- GIB was associated with a 27% lower rate of cardiac transplantation in eligible patients (rate ratio 0.73, p < 0.05).
Conclusions:
- GIB is a significant complication after CF-LVAD implantation.
- GIB may reduce cardiac transplantation rates, potentially mediated by increased blood transfusions and allosensitization.
Abstract:
Gastrointestinal bleeding (GIB) remains a significant problem after continuous-flow left ventricular assist device (CF-LVAD) implantation. We hypothesized that the subsequent need for blood transfusions in patients with GIB may reduce rates of cardiac transplantation. We performed a retrospective review of 232 patients implanted with the HeartMate II (HM II) CF-LVAD from June 2005 through May 2013 at our center to determine risk factors for GIB and assess its effect on cardiac transplantation. Over a total LVAD follow-up time of 364 person-years, 62 GIB episodes occurred in 49 patients (27%), for an event rate of 0.45 gastrointestinal bleeds/patient-year of LVAD support. Women made up 15% of our cohort, yet contributed 29% of the GIB (p = 0.06). Survival at 6 month, 1 year, and 2 years was not statistically different in patients who developed GIB and those who did not (77% vs 78%, 74% vs 71%, and 61% vs 54%, respectively). In transplant-eligible patients, GIB was associated with a 27% lower rate of cardiac transplantation (rate ratio 0.73, p < 0.05). Although the mechanism behind this finding is unclear, GIB appears to be linked to higher transfusion rates, which may cause the development of subsequent allosensitization.
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