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Limited usefulness of endoscopic evaluation in patients with continuous-flow left ventricular assist devices and

Jordan E Axelrad1, Alberto Pinsino2, Pauline N Trinh3

  • 1Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, New York, USA.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|February 7, 2018
PubMed

Insights

Gastrointestinal bleeding in continuous-flow left ventricular assist device patients often presents as occult bleeding. A new algorithm could reduce endoscopic procedures and costs by 45% and 35%, respectively.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Medical Devices

Background:

  • Gastrointestinal bleeding (GIB) is a common complication and cause of re-admission in patients with continuous-flow left ventricular assist devices (CF-LVADs).
  • GIB management in these patients involves frequent endoscopic procedures, leading to high healthcare resource utilization.

Purpose of the Study:

  • To evaluate the diagnostic and therapeutic yield of endoscopic procedures for GIB in CF-LVAD recipients.
  • To develop a more cost-effective management strategy for GIB in this patient population.

Main Methods:

  • Retrospective review of 428 patients implanted with CF-LVADs between 2009 and 2016.
  • Categorization of GIB into upper (UGIB), lower (LGIB), and occult (OGIB) based on clinical presentation.
  • Analysis of 164 GIB events and 239 endoscopic procedures.

Main Results:

  • Occult GIB was the most frequent presentation (43.7%).
  • Endoscopy localized a bleeding source in only 30% of index GIB events, with 16.3% requiring endoscopic intervention.
  • Arteriovenous malformations (AVMs) were the most common identified lesions (48.9%).
  • Gastric/small bowel source and endoscopic intervention predicted recurrent GIB.

Conclusions:

  • Occult GIB is prevalent in CF-LVAD patients and has low diagnostic/therapeutic yield via endoscopy.
  • Endoscopic interventions are associated with recurrent GIB.
  • A proposed algorithm may reduce low-yield procedures by 45% and costs by 35%, improving resource utilization.
Abstract

Keywords:
AVM, arterial venous malformationsCF-LVAD, continuous flow left ventricular assist deviceLGIB, lower gastrointestinal bleedingOGIB, occult gastrointestinal bleedingUGIB, upper gastrointestinal bleeding

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