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A Multicenter Study of Left Ventricular Assist Device-Related Gastrointestinal Bleeding
Joseph Dailey1, Long H Nguyen2,3, Arushi Kohli1
1Division of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA.
Clinical and Translational Gastroenterology
|August 25, 2022
Summary
Gastrointestinal bleeding (GIB) is common in patients with continuous left ventricular assist devices (LVADs). Destination therapy LVADs and prior GIB increase recurrent bleeding risk, with low diagnostic yield for occult bleeds.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Continuous left ventricular assist devices (LVADs) support advanced heart failure patients.
- Gastrointestinal bleeding (GIB) is a frequent complication in LVAD recipients.
- Medically fragile patients with LVADs are particularly susceptible to GIB.
Purpose of the Study:
- To analyze the incidence and predictors of GIB in LVAD patients.
- To evaluate the diagnostic yield of endoscopic procedures for GIB in LVAD recipients.
- To identify risk factors for recurrent GIB after LVAD implantation.
Main Methods:
- Retrospective analysis of 475 LVAD implantations from 2008-2019.
- Identification and characterization of 128 patients with clinically significant GIB.
- Analysis of overt vs. occult GIB presentations and predictors of recurrence.
Main Results:
- 128 patients experienced GIB post-LVAD implantation.
- Overt GIB was more common than occult GIB.
- Destination therapy LVADs and prior GIB history independently predicted recurrent GIB hospitalization.
Conclusions:
- GIB is highly prevalent in LVAD patients, particularly those receiving destination therapy.
- Endoscopic evaluation has a low diagnostic yield for occult GIB in this population.
- Recurrent GIB is common, underscoring the need for effective management strategies.
