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Pre-left ventricular assist device endoscopic evaluation does not reduce the risk of later gastrointestinal bleeding:
Jiahao Peng1, Samanthika Devalaraju2, Mohamed Azab3
1Center for Health Research, Loma Linda University Health, Loma Linda, California (Jiahao Peng).
Insights
Preoperative endoscopy before left ventricular assist device (LVAD) implantation was associated with a higher risk of gastrointestinal bleeding (GIB). This study suggests endoscopic screening may not be warranted to prevent post-LVAD GIB.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Complications
Background:
- Gastrointestinal bleeding (GIB) is a frequent complication following left ventricular assist device (LVAD) implantation.
- Some medical centers utilize preoperative endoscopy to potentially reduce the incidence of post-LVAD GIB.
- This study investigates the association between preoperative endoscopy and the risk of GIB after LVAD placement.
Purpose of the Study:
- To evaluate whether preoperative endoscopy is linked to a reduced risk of gastrointestinal bleeding (GIB) after left ventricular assist device (LVAD) implantation.
- To determine the impact of preoperative endoscopic screening on the incidence of GIB in LVAD patients.
Main Methods:
- A multicenter cohort study included 398 patients undergoing LVAD insertion between 2010 and 2019.
- Participants were divided into two groups: those who underwent preoperative endoscopy and those who did not.
- The primary outcome was GIB within one year post-LVAD, with secondary outcomes including severe bleeding and intraprocedural complications.
Main Results:
- A total of 114 patients (28.6%) experienced GIB within one year.
- The incidence of GIB was higher in the preoperative endoscopy cohort (36.4%) compared to the no-endoscopy cohort (24.8%, P=0.015).
- After adjusting for covariates, preoperative endoscopy remained associated with an increased risk of GIB (aOR 1.77, P=0.032). Arteriovenous malformations and peptic ulcer disease were the most common GIB sources.
Conclusions:
- Preoperative endoscopy before LVAD implantation appears to be associated with an elevated risk of subsequent GIB.
- Despite controlling for confounders, the findings suggest that routine endoscopic screening may not be beneficial for preventing GIB in this patient population.
- Further research may be needed to fully elucidate the complex relationship between preoperative interventions and post-LVAD complications.
Background:
Gastrointestinal bleeding (GIB) is a common complication after placement of a left ventricular assist device (LVAD). Some institutions attempt to mitigate post-LVAD GIB using preoperative endoscopy. Our study evaluated whether preoperative endoscopy was associated with a lower risk of post-LVAD GIB.
Methods:
This was a multicenter cohort study of patients who underwent LVAD insertion from 2010-2019 at 3 academic sites. A total of 398 study participants were categorized based on whether they underwent preoperative endoscopy or not. The follow-up period was 1 year and the primary outcome was GIB. Secondary outcomes were severe bleeding and intraprocedural complications.
Results:
A total of 114 patients experienced GIB within 1 year, with a higher rate in the endoscopy cohort (36.4% vs. 24.8%, P=0.015). After adjusting for covariables, the endoscopy cohort remained at increased risk of GIB (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.976; P=0.032). Severe bleeding was common (47.4%). Arteriovenous malformations (48 cases) and peptic ulcer disease (17 cases) were the most identified sources of GIB. Only 1 minor adverse event occurred during preoperative endoscopy.
Conclusions:
Our study suggests that pre-LVAD endoscopy is associated with a higher risk of GIB post LVAD, despite controlling for confounders. While this was an observational study and may not have captured all confounders, it appears that endoscopic screening may not be warranted.
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