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Updated: Feb 13, 2026

Engineering Biological-Based Vascular Grafts Using a Pulsatile Bioreactor
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Published on: June 14, 2011

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Association of Pulsatility with Gastrointestinal Bleeding in a Cohort of HeartMate II Recipients

Adam L Edwards1, Paul Fitzmorris1, Salpy V Pamboukian2

  • 1From the Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|March 1, 2018
PubMed

Insights

A low pulsatility index (PI) in patients with continuous-flow left ventricular assist devices (CF-LVADs) is linked to a higher risk of gastrointestinal bleeding (GIB). This finding emphasizes the importance of monitoring blood flow dynamics in CF-LVAD recipients.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Biomedical Engineering

Background:

  • Gastrointestinal bleeding (GIB) is a frequent complication in patients with continuous-flow left ventricular assist devices (CF-LVADs).
  • Altered blood flow dynamics secondary to CF-LVADs are hypothesized to contribute to GIB.
  • The pulsatility index (PI) is a measure of blood flow pulsatility that may reflect these hemodynamic changes.

Purpose of the Study:

  • To investigate the association between a low pulsatility index (PI) and the risk of overt gastrointestinal bleeding (GIB) in patients implanted with a HeartMate II (HMII) continuous-flow left ventricular assist device (CF-LVAD).

Main Methods:

  • Retrospective cohort study involving 95 patients with HMII CF-LVADs.
  • PI was measured at multiple intervals post-implantation (48 hours, 1, 3, and 6 months).
  • Overt GIB occurring during hospitalization between 6 days and 6 months post-implantation was the primary endpoint. Multivariable analysis was used to assess predictors of GIB.

Main Results:

  • Seventeen (18%) patients experienced overt GIB.
  • Low PI (< 4.15) was defined based on receiver operating characteristic curve analysis.
  • After adjusting for baseline hemoglobin, a low PI was independently associated with an increased hazard of overt GIB.

Conclusions:

  • A low pulsatility index is an independent predictor of increased gastrointestinal bleeding hazard in HeartMate II CF-LVAD recipients.
  • Monitoring PI may help identify patients at higher risk for GIB.
  • Further research into the mechanisms linking low PI and GIB in CF-LVAD patients is warranted.

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