Related Experiment Video
Updated: Dec 21, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Characteristics and outcomes of gastrointestinal bleeding in patients with continuous-flow left ventricular assist
Laura A Carlson1, Elizabeth J Maynes1, Jae Hwan Choi1
1Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Gastrointestinal bleeding (GIB) is common after continuous-flow left ventricular assist device (CF-LVAD) implantation, often caused by arteriovenous malformations. Heart transplantation effectively resolves GIB risk in CF-LVAD patients.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Gastrointestinal bleeding (GIB) is a significant complication following continuous-flow left ventricular assist device (CF-LVAD) implantation.
- Understanding GIB patterns and outcomes is crucial for managing CF-LVAD recipients.
Purpose of the Study:
- To evaluate the incidence, timing, and etiology of GIB in patients with CF-LVAD.
- To assess the outcomes associated with GIB, including mortality and thromboembolic events.
- To investigate the impact of heart transplantation on recurrent GIB.
Main Methods:
- Systematic electronic search of studies reporting GIB in CF-LVAD patients.
- Meta-analysis of data from 34 studies involving 1087 patients.
- Analysis of patient demographics, GIB characteristics, and clinical outcomes.
Main Results:
- The mean time to first GIB was 54 days post-implantation, with 40% experiencing multiple episodes.
- Arteriovenous malformations were the most common cause (36%).
- Mortality from GIB was 4%, while thromboembolic events occurred in 32% of patients.
- Heart transplantation resolved GIB in all patients who underwent the procedure.
Conclusions:
- Gastrointestinal bleeding is a major source of morbidity in CF-LVAD recipients.
- While GIB-related mortality is low, anticoagulation management is critical to prevent thrombotic events.
- Heart transplantation appears to be a definitive solution for GIB in this patient population.
Abstract:
Gastrointestinal bleeding (GIB) is a common adverse event after continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate patterns of GIB development and related outcomes in CF-LVAD recipients. An electronic search was performed to identify all articles related to GIB in the setting of CF-LVAD implantation. A total of 34 studies involving 1087 patients were pooled for analysis. Mean patient age was 60 years (95% CI 57-64) and 24% (95% CI 21-28%) were female. The mean time from CF-LVAD implantation to the first GIB was 54 days (95% CI 24-84) with 40% (95% CI 34-45%) of patients having multiple episodes of GIB. Anemia was present in 75% (95% CI 41-93%) and the most common etiology of bleeding was arteriovenous malformations (36% [95% CI 24-50%]). The mean duration of follow-up was 14.6 months (95% CI 6.9-22.3) during which the all-cause mortality rate was 21% (95% CI 12-36%) and the mortality rate from GIB was 4% (95% CI 2-9%). Thromboembolic events occurred in 32% (95% CI 22-44%) of patients with an ischemic stroke rate of 16% (95% CI 3-51%) and a pump thrombosis rate of 8% (95%CI 3-22%). Heart transplantation was performed in 31% (95% CI 18-47%) of patients, after which 0% (95% CI 0-10%) experienced recurrent GIB. GIB is a major source of morbidity among CF-LVAD recipients. While death due to GIB is rare, cessation of anticoagulation during treatment increases the risk of subsequent thrombotic events. Heart transplant in these patients appears to reliably resolve the risk of future GIB.
More Related Videos
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:29Cardiomyopathy V: Interprofessional Care