Evaluation of GI bleeding after implantation of left ventricular assist device

Vladimir M. Kushnir, Shivak Sharma, Gregory A. Ewald, Jonathan Seccombe, Eric Novak, I. Wen Wang, Susan M. Joseph, C. Prakash Gyawali

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Background: Left ventricular assist devices (LVADs) have revolutionized the management of end-stage heart failure (ESHF). However, unexpectedly high rates of GI bleeding (GIB) have been described, and etiology and outcome remain unclear. Objective: To determine the prevalence, etiology, and outcome of GIB in LVAD recipients. Design: Retrospective case series. Setting: Tertiary care academic university hospital. Patients: 154 ESHF patients (55.4 years, 122 men/32 women) with LVADs implanted over a 10-year period. Main outcome measurements: Overt or occult GIB prompting endoscopic evaluation <7 days after LVAD implantation. Results: Over a mean of 0.9 ± 0.1 years of follow-up, 29 patients (19%) experienced 44 GIB episodes. Patients with GIB were older and received anticoagulation therapy before devices were implanted (P ≤.02 for each). GIB was overt (n = 31) rather than occult (n = 13), and most patients presented with melena (n = 22, 50%); hemodynamic instability was observed in 13.6%. Each bleeding episode required 2.1 ± 0.1 diagnostic or therapeutic procedures, and a source was localized in 71%. Upper endoscopy provided the highest diagnostic yield; peptic bleeding (n = 14) and vascular malformations (n = 8) dominated the findings. Endoscopy was safe and well tolerated. Overall mortality was 35%, none directly from GIB. Limitation: Retrospective design. Conclusions: Rates of GIB with LVADs are higher than that seen in other patient populations, including those receiving anticoagulation and antiplatelet therapy. GIB episodes are mostly overt and predominantly from the upper GI tract. Endoscopy is safe in the LVAD population.

Original languageEnglish (US)
Pages (from-to)973-979
Number of pages7
JournalGastrointestinal endoscopy
Volume75
Issue number5
DOIs
StatePublished - May 1 2012

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Keywords

  • BTT
  • CHF
  • DT
  • ESHF
  • GI bleeding
  • GIB
  • HM II
  • HeartMate II
  • ICU
  • INR
  • IQR
  • LVAD
  • NSAID
  • PPI
  • PUD
  • bridge to transplant
  • congestive heart failure
  • destination therapy
  • end-stage heart failure
  • intensive care unit
  • international normalized ratio
  • interquartile range
  • left ventricular assist device
  • nonsteroidal anti-inflammatory drug
  • peptic ulcer disease
  • proton pump inhibitor
  • vWF
  • von Willebrand factor

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Kushnir, V. M., Sharma, S., Ewald, G. A., Seccombe, J., Novak, E., Wang, I. W., Joseph, S. M., & Gyawali, C. P. (2012). Evaluation of GI bleeding after implantation of left ventricular assist device. Gastrointestinal endoscopy, 75(5), 973-979. https://doi.org/10.1016/j.gie.2011.12.014