Gastrointestinal bleeding with the HeartMate II left ventricular assist device

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• 作者：Jeffrey A. Morgan ; MD^a ; ^{jmorgan2@hfhs.org} ; Gaetano Paone ; MD^a ; Hassan W. Nemeh ; MD^a ; Scott E. Henry ; MD^a ; Rosan Patel ; BA^a ; Jessica Vavra ; BA^a ; Celeste T. Williams ; MD^b ; David E. Lanfear ; MD^b ; Cristina Tita ; MD^b ; Robert J. Brewer ; MD^a
• 关键词：heart failure ; left ventricular assist device ; LVAD ; gastrointestinal ; bleeding
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2012
• 出版时间：July, 2012
• 年：2012
• 卷：31
• 期：7
• 页码：715-718
• 全文大小：268 K

文摘

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Background

Continuous flow left ventricular assist devices (CF-LVADs) have yielded improved outcomes compared with pulsatile flow devices for patients on long-term support. However, significant rates of gastrointestinal bleeding (GIB) have been observed during CF-LVAD support.

Methods

From March 2006 through March 2011, 86 patients with chronic heart failure underwent implantation of a CF-LVAD (HeartMate II; Thoratec Corp., Pleasanton, CA). Records were reviewed to determine the prevalence of post-implant GIB, location of the bleeding site and associated morbidity and mortality. Uni- and multivariate analyses were conducted to identify independent predictors of GIB.

Results

GIB occurred in 19 patients (22.1 % ) with a duration of support that ranged from 5 to 456 days. Sources of GIB included small bowel and rectum in 6 patients each, large bowel in 2 patients and stomach in 1 patient. No definite source was identified in 4 patients. There were no deaths referable to GIB. Recurrent GIB occurred in 4 patients. History of a GIB prior to LVAD implant was the only variable significantly different between patients with and without post-implant GIB (21.1 % vs 10.4 % , p = 0.016), and was the only independent predictor of GIB (OR = 2.24, 95 % CI 2.121 to 2.435, p = 0.004).

Conclusions

Gastrointestinal bleeding is a frequent source of morbidity for patients on HeartMate II LVAD support but does not significantly impact survival. As 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 be needed for minimizing this complication.