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Intractable Hematuria After Left Ventricular Assist Device Implantation: Can Lessons Learned from Gastrointestinal

Andre Y Son1, Lee Zhao, Alex Reyentovich

  • 1From the *Department of Cardiothoracic Surgery, †Department of Urology, and ‡Division of Cardiology, New York University-Langone Medical Center, New York, New York.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|October 14, 2015
PubMed

Insights

Gross hematuria is a rare but serious bleeding complication in patients with continuous-flow left ventricular assist devices (CF-LVADs). Avoiding urinary tract trauma is crucial to prevent this adverse event.

Area of Science:

  • Cardiology
  • Urology
  • Medical Devices

Background:

  • Patients with continuous-flow left ventricular assist devices (CF-LVADs) face an elevated risk of bleeding complications.
  • Gastrointestinal (GI) bleeding is the most frequently reported mucosal bleeding site in CF-LVAD patients.
  • Urinary tract bleeding is a less common but potentially severe complication.

Purpose of the Study:

  • To review institutional experience with urinary tract bleeding (gross hematuria) after CF-LVAD implantation.
  • To quantify the impact of gross hematuria on hospital resource utilization.
  • To compare hematuria complications with GI bleeding in CF-LVAD patients.

Main Methods:

  • Retrospective review of patient records undergoing CF-LVAD implantation (October 2011 - April 2015).
  • Identification and analysis of major adverse events, specifically gross hematuria and GI bleeding.
  • Comparison of patient demographics and hospital course, including length of stay and readmission rates.

Main Results:

  • Gross hematuria occurred in 8.6% of patients and 5.1% of hospitalizations.
  • Severe hematuria was associated with urethral catheterization, urinary retention, or urologic surgery.
  • Hospitalizations for hematuria were less frequent but 3.2 times longer than for GI bleeding (17.0 vs. 5.3 days).
  • Late recurrent gross hematuria occurred in all cases, leading to readmission.

Conclusions:

  • Gross hematuria is an infrequent yet morbid bleeding complication in CF-LVAD recipients.
  • Preventive strategies should focus on avoiding traumatic urethral catheterization and urinary retention.
  • Careful management of the urinary tract is essential in high-risk CF-LVAD patients.

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