Curative Radical Jejunectomy for a Refractory Upper Gastrointestinal Bleed in a HeartMate 3 Left Ventricular Assist...

Gastrointestinal bleeding (GIB) is a known complication in patients with left ventricular assist devices (LVADs), and can be difficult to manage when bleeding is recurrent or unresponsive to standard therapies. We describe the case of a 63-year-old woman with a HeartMate 3 LVAD who presented with repeated episodes of GIB. Extensive evaluation revealed jejunal angiodysplasia as the source. Despite multiple endoscopic treatments and temporary discontinuation of anticoagulation, the bleeding persisted. Ultimately, the patient underwent exploratory laparotomy with resection of approximately 100 cm of proximal jejunum, which successfully resolved the bleeding. This case demonstrates that surgical intervention can be an effective option for refractory GIB due to angiodysplasia in LVAD patients, and underscores the importance of a multidisciplinary approach when balancing bleeding and thrombotic risks.