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Cessation of Continuous Flow Left Ventricular Assist Device-Related Gastrointestinal Bleeding After Heart
Insights
Continuous flow left ventricular assist device (CF LVAD) therapy can cause gastrointestinal bleeding (GIB). Heart transplantation effectively eliminates CF LVAD-related GIB, justifying transplant prioritization for patients experiencing recurrent bleeding.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Gastrointestinal bleeding (GIB) is a significant complication of continuous flow left ventricular assist device (CF LVAD) therapy.
- The underlying mechanisms of CF LVAD-related GIB are not fully understood.
- The impact of CF LVAD removal during heart transplantation on GIB recurrence has not been previously investigated.
Purpose of the Study:
- To investigate the incidence and characteristics of GIB in patients with CF LVAD.
- To identify factors associated with GIB in CF LVAD patients.
- To determine the frequency and causes of recurrent GIB after heart transplantation in patients who previously experienced GIB with CF LVAD support.
Main Methods:
- A single-center retrospective review of patients who received CF LVAD and developed GIB.
- Comparison of baseline demographics and pulsatility markers (aortic valve opening, HeartMate II pulse index) between patients with and without GIB.
- Assessment of GIB recurrence and etiology in patients who underwent heart transplantation after CF LVAD support.
Main Results:
- GIB occurred in 25% of patients (54/214), with 88 total events (0.36 events/patient-year).
- Arteriovenous malformation (AVM) was the etiology in 36% of GIB episodes.
- Older age and lower HeartMate II pulse index were significantly associated with GIB on multivariate analysis.
- None of the 28 patients who underwent transplantation after experiencing GIB with CF LVAD had recurrent bleeding post-transplant.
Conclusions:
- Heart transplantation effectively resolves CF LVAD-related GIB.
- Transplant prioritization for patients with recurrent GIB on CF LVAD is clinically justified.
- Further research into the pathophysiology of CF LVAD-related GIB is warranted.
Abstract:
Gastrointestinal bleeding (GIB) is a major complication of continuous flow left ventricular assist device (CF LVAD) therapy. The precise pathophysiology of CF LVAD-related bleeding remains poorly understood, and the effect of pump removal at the time of transplantation on actual bleeding frequency has not previously been studied. A single-center retrospective review was conducted on patients who received CF LVAD and subsequently developed GIB. Baseline demographics and markers of pulsatility (aortic valve opening and the HeartMate II [HM2] pulse index) were compared between those with and without GIB. In those patients who had GIB and proceeded to heart transplantation, the frequency and etiology of recurrent GIB post-transplant was assessed. A total of 88 GIBs occurred in 54 of 214 patients who received CF LVAD implantation (25%, 0.36 events per patient-year). Median time to first bleeding was 65 (interquartile range [IQR]: 37-229) days, and arteriovenous malformation (AVM) was the etiology in 36% of all episodes. On multivariate analysis, age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01-1.09; p = 0.006) and HM2 pulse index (OR: 0.57; 95% CI: 0.35-0.90; p = 0.017) were significantly associated with GIB. There were 28 patients who had at least one GIB event during LVAD support and proceeded to transplant. None of these patients had recurrent bleeding after heart transplantation. This is the first documentation that transplantation effectively eliminates CF LVAD-related GIB. Current guidelines recommending prioritization for transplant for patients who develop recurrent GIB after CF LVAD are justified.
