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Published on: June 12, 2021
Gastrointestinal Bleeding in Patients Who Underwent HeartMate 3 Left Ventricular Assist Device Implantation
Jonathan Eisenberger1, David Koren1, Shmuel Somer1
1Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Insights
Gastrointestinal bleeding (GIB) affects 14% of patients with HeartMate 3 left ventricular assist devices (HM3-LVADs), causing morbidity but not impacting survival. Further understanding of GIB pathophysiology is needed to reduce its occurrence.
Area of Science:
- Cardiology
- Medical Devices
- Gastroenterology
Background:
- Continuous-flow left ventricular assist devices (CF-LVADs) offer improved outcomes over pulsatile devices.
- Gastrointestinal bleeding (GIB) remains a significant complication in CF-LVAD patients.
- The HeartMate 3 left ventricular assist device (HM3-LVAD) features an artificial pulse, potentially reducing GIB compared to earlier models like the HeartMate 2 (HM2-LVAD).
Purpose of the Study:
- To determine the incidence of GIB in patients receiving HM3-LVAD support.
- To identify predictors of GIB in this patient population.
- To evaluate the clinical outcomes and mortality associated with GIB in HM3-LVAD recipients.
Main Methods:
- A retrospective review of 180 patients who underwent HM3-LVAD implantation between 2016 and 2024.
- Analysis of patient records to ascertain GIB prevalence, bleeding sources, and associated morbidity/mortality.
- Univariate and multivariate statistical analyses to identify independent predictors of GIB.
Main Results:
- GIB occurred in 14% (25/180) of patients, with bleeding sources including the small bowel, rectum, large bowel, and stomach, and 11 cases with no clear source.
- Recurrent GIB was observed in 64% (16/25) of affected patients.
- No deaths were attributed to GIB, and no demographic or historical factors independently predicted GIB development.
Conclusions:
- GIB is a common cause of morbidity in patients supported by HM3-LVADs.
- While GIB is frequent, it does not significantly affect patient survival.
- Further research into the pathophysiology of GIB in CF-LVAD patients is crucial for developing strategies to mitigate this complication.
Background:
Continuous-flow left ventricular assist devices (CF-LVADs) have yielded improved outcomes compared with pulsatile-flow devices; however, significant rates of gastrointestinal bleeding (GIB) have been observed. The HeartMate 3 left ventricular assist device (HM3-LVAD) (Abbott, Inc., Chicago, IL, USA) includes new features, such as an artificial pulse, which may decrease GIB prevalence compared to the HeartMate 2 left ventricular assist device (HM2-LVAD).
Objectives:
To evaluate the incidence, predictors, and clinical outcomes of GIB in patients supported by the HM3-LVAD.
Methods:
From 2016 until 2024, 180 patients with chronic heart failure underwent HM3-LVAD implantation. Records were reviewed to determine the post-implant GIB prevalence, location of the bleeding, and associated morbidity and mortality. Univariate and multivariate analyses were conducted to identify independent predictors of GIB.
Results:
GIB occurred in 25 patients (14%) with a duration of support ranging from 1 to 1821 days. Sources of GIB included the small bowel and rectum in eight patients each, large bowel in one, and stomach in two. No clear source was identified in 11 patients. Recurrent GIB occurred in 16 patients (64%). There were no deaths attributable to GIB. None of the historical or demographic parameters were found to be independent predictors of GIB.
Conclusions:
GIB is a frequent source of morbidity for patients on HM3-LVAD support but does not significantly impact survival. As the implantation of CF-LVADs with non-pulsatile flow gains popularity for both bridge-to-transplant and destination therapy, a better understanding of the pathophysiology of GIB in these patients will reduce the prevalence of this complication.
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