Early Gastrointestinal Complications From Ventricular Assist Devices is Increased by Non-Pulsatile Flow

Area of Science:

• Cardiovascular Surgery
• Gastroenterology
• Biomedical Engineering

Background:

• Non-pulsatile blood flow from centrifugal ventricular assist devices (VADs) may impair splanchnic perfusion.
• This impairment could lead to gastrointestinal (GI) complications and bowel ischemia, especially during early post-implantation circulatory instability.

Purpose of the Study:

• To compare the incidence of GI complications in patients receiving non-pulsatile VADs versus pulsatile VADs.

Main Methods:

• A pilot study compared 12 patients with non-pulsatile Ventrassist devices to 11 with pulsatile Thoratec devices.
• A larger study analyzed 53 patients with non-pulsatile devices and 110 with pulsatile devices implanted between 1992 and 2012.
• GI complications requiring intervention (surgical, endoscopic, radiological) were recorded.

Main Results:

• The full study revealed significantly higher rates of GI bleeding (23% vs 4%), endoscopies (24% vs 12%), and delayed nasogastric feed absorption (35% vs 7%) in non-pulsatile VAD recipients.
• Overall GI complications were substantially higher with non-pulsatile devices (56%) compared to pulsatile devices (20%).
• Non-pulsatile VADs were associated with a significantly higher odds of developing GI complications (odds ratio 0.07).

Conclusions:

• Non-pulsatile centrifugal VADs are associated with a greater incidence of GI hemorrhagic and ischemic complications compared to pulsatile VADs.
• These complications are most pronounced in the early post-implantation period.
• Further research is needed to determine if increasing pulsatility in centrifugal devices can mitigate these GI complications.