Evolution of Gastrointestinal Bleeding in Patients Supported With Continuous-Flow Left Ventricular Assist Devices

We assessed characteristics and risk factors of gastrointestinal (GI) bleeding in patients with continuous-flow left ventricular assist devices (CF-LVAD) in our institutional Intermacs database (2008-2023). Patient characteristics were reported as frequencies/proportions for categorical variables and as median/interquartile range (IQR) for continuous variables. Multivariable Cox proportional hazards regression identified GI bleeding risk factors. Among 1,030 CF-LVADs implanted, the median age was 58.5 years (IQR: 50.4-65.4), and 79.4% were male. Pre-implant Intermacs profile less than or equal to 3 was seen in 80.6%. Axial-flow LVADs were used in 55.2%, partially magnetically levitated centrifugal-flow in 30.7%, and fully magnetically levitated centrifugal-flow in 14.1%. GI bleeding occurred in 37.5% (13.9 per 100 person-years), with 65.3% rebleeding. Bleeding sources: 54.4% upper GI, 21.8% lower GI, and 23.8% unknown. The median time from LVAD implant to first GI bleeding was 5 months (IQR: 1-19); to any GI bleeding was 11 months (IQR: 2-31). Patients older than 50 years were three times more likely to develop GI bleeding (hazard ratio [HR]: 3.15, p < 0.001). Fully magnetically levitated centrifugal-flow LVADs reduced GI bleeding risk by four times compared to axial-flow LVADs (HR: 0.26, p < 0.001). Coronary artery disease (HR: 1.49, p = 0.022) and chronic kidney disease (HR: 1.91, p = 0.001) nearly double the risk of GI bleeding.