Abstract 16687: The Incidence and Etiology of GI Bleeding in Patients Supported by Continuous Flow Left Ventricular Assist Device
Introduction Gastrointestinal (GI) bleeding is a frequent adverse event reported with continuous flow LVADs which may be explained by acquired von Willebrand disease and antithrombotic therapy. The aim of this study was to determine the incidence and etiology of GI bleeding among patients supported by a HeartMate II (HM II) LVAD.
Methods A retrospective chart review was performed for all HM II patients implanted from 2004 to 2011. GI work-up included gastroscopy, colonoscopy, capsule studies, and small bowel enteroscopy and was reviewed by a gastroenterologist and a pathologist. GI bleeding was defined as occult or obvious blood in the stool with concomitant drop in hemoglobin.
Results 142 patients aged 56.7±14.9 years were implanted with a HM II. 77% of patients were male and the etiology was ischemic cardiomyopathy in 44%. 74% of LVADs were placed as a bridge to transplant. The rate of GI bleeding was 0.36 events / year. A total of 51 events occurred in 28 patients. The indications for GI work-up were melena (46% of patients), hematochezia (14%), heme-positive stool (14%) and iron deficiency anemia (25%). Full GI work-up (gastroscopy, colonoscopy and capsule study) was performed in 7 patients; 12 patients had gastroscopy and colonoscopy only; and 7 underwent only gastroscopy. The source of bleeding was identified in 71% of patients. Duodenal ulcer was the most prevalent identified source and occurred in 21% of patients (see figure). Only 5 patients had therapeutic interventions performed. Gastric biopsy was performed in 7 patients of which 6 had reactive features including mucous depletion, foveolar hyperplasia, fibromuscular hyperplasia of the stroma, and dilated or congested capillaries.
Conclusions A high incidence of GI bleeding was found among patients supported with a continuous flow device, with gastric ulcers as the most prevalent etiology. Evaluation for H. pylori infection and proton pump inhibitor use should be studied in continuous flow LVAD patients.
- © 2011 by American Heart Association, Inc.