Gastrointestinal bleeding with left ventricular assist devices (LVAD): Locating the leak and identifying outcomes

Sarah Malik, Shahbaz A. Malik, Laura L. Ulmer, Lokesh K. Jha, Michael S. Strupp, Eugenia Raichlin, Elizabeth R. Lyden, Alexander T. Hewlett

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background and Goals: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. Study: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups. Results: Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P=0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P=0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤ 0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P= 0.01) and the mortality rate during hospitalization for GIB was 11% (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P=0.016). Conclusions: Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.

Original languageEnglish (US)
Pages (from-to)E202-E207
JournalJournal of Clinical Gastroenterology
Volume53
Issue number5
DOIs
StatePublished - May 1 2019

Keywords

  • Gastrointestinal bleeding
  • Left ventricular assist device
  • Outcome research

ASJC Scopus subject areas

  • Gastroenterology

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