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ASAIO J. 2019 Apr 4. doi: 10.1097/MAT.0000000000000998. [Epub ahead of print]

Gastrointestinal Bleeding After HeartMate II or HVAD Implantation: Incidence, Location, Etiology, and Effect on Survival.

Author information

1
From the Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas.
2
Department of Cardiopulmonary Transplantation, the Center for Cardiac Support, Texas Heart Institute, Houston, Texas.
3
Division of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital, Institute of Gerontology, Tokyo, Japan.
4
Department of Surgery, Baylor College of Medicine, Houston, Texas.

Abstract

The number of patients on destination therapy is increasing as long-term survival on continuous-flow left ventricular assist device (CF-LVAD) therapy has improved. Gastrointestinal bleeding (GIB) is a common complication after CF-LVAD implantation, and its risk correlates with longer support time, emphasizing the importance of GIB management. The lower pulsatility of CF-LVADs may promote arteriovenous malformations, that amplify the bleeding risk. Here, we retrospectively analyzed the location, incidence, and survival effect of GIB events in Heartmate II (HM-II) and HVAD recipients to provide specific details regarding these complications. From November 2003 to March 2016, 526 patients with chronic heart failure underwent primary implantation of an HM-II (n = 403) or HVAD (n = 123) CF-LVAD at our center. Of the 526 patients, 140 (26.6%) had a GIB event (HM-II: n = 100; HVAD: n = 40), 92 (17.5%) had a single GIB event, and 48 (9.1%) had multiple GIB events (range: 2-9 events). HVAD recipients had a higher incidence of both upper and lower GIB events (p < 0.001 and P = 0.002, respectively) than HM-II recipients. Arteriovenous malformation was the most common etiology for GIB (50 patients/72 events); for this group, the average time-to-event was 300.4 days, the recurrence rate was 34%, and the 90-day and 1-year survival rates were 88.3% and 66.7%, respectively. Age at implantation was the only predictor of GIB. In conclusion, our study provides detailed information about GIB events associated with current CF-LVADs. Additional studies are required to evaluate strategies to reduce the incidence of GIB morbidity.

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