Abstract 16781: Nasal Microvasculature Changes During Continuous Flow Left Ventricular Assist Device (CF-LVAD) Support
Introduction: Gastrointestinal (GI) bleeding is a frequent and significant cause of morbidity after CF-LVAD and is thought to be secondary to mucosal vascular abnormalities. Epistaxis is also a frequent complication and we hypothesized that the nasal mucosa might be a more accessible surrogate to study changes in microvasculature during CF-LVAD support. We sought to systematically characterize intranasal mucosal vascular abnormalities in a cohort of CF-LVAD subjects.
Methods: Subjects were recruited from the LVAD clinic at Montefiore Medical Center if they were ≥ 60 days post implantation. Systematic evaluation of intranasal vasculature was performed with nasal endoscopy using both a 0 degree and 30 degree endoscope with 3 passes into each nasal cavity. The sites of all vascular abnormalities were recorded with particular attention to areas of hemorrhage and the presence of dilated vasculature which is a risk factor for future hemorrhage.
Results: Twelve men, median age 55 (25-75) years, 42% ischemic etiology, who were supported with CF-LVAD (10 HeartMateII, 2 HeartWare) were enrolled. Median length of support on the device at the time of nasal endoscopy was 315 (74-731) days. All patients were maintained on aspirin 325mg daily and coumadin (within guideline INR at time of testing). On nasal endoscopy, 11 (91.7%) subjects had evidence of prior hemorrhage and, interestingly, only 2 of these reported a clinical history of epistaxis. Ten (83.3%) patients demonstrated areas of dilated vasculature while no patients had entirely normal mucosa (Table 1).
Conclusions: In a small cohort of unselected CF-LVAD, all subjects demonstrated abnormal intranasal vascular findings. CF-LVAD support may be associated with disseminated microvascular changes and the nasal mucosa offers a more readily accessible model to study these changes.
- © 2013 by American Heart Association, Inc.