Abstract 17042: Unique Hemodynamic Parameters Predict GI Bleeding in Patients With Continuous Flow Ventricular Assist Devices
Introduction: Gastrointestinal (GI) bleeding remains a major morbid event during continuous flow left ventricular assist device (LVAD) support.
Hypothesis: This study investigated whether a common hemodynamic profile may be associated with GI bleeding in patients with continuous flow LVADs.
Methods: A single institution analysis reviewed all adult patients who underwent right heart caths (RHC) following LVAD implant between 1/1/2006 and 12/31/2013 with follow-up through 6/2015. Kaplan-Meier and hazard function statistical methods were employed.
Results: Among 108 patients with 341 RHCs, 55 hospitalizations for GI bleeding occurred within 1 year of a RHC. Freedom from GI bleed at 6 months was 93% in patients with pulse pressure >35 mmHg measured by blood pressure cuff, compared to 77% with pulse pressure <35. By multivariable analysis, the significant predictors at time of RHC of a subsequent GI bleed were: older age at implant, number of prior GI bleeds, lower pulse pressure, lower mean blood pressure, and higher right atrial/capillary wedge pressure (all p<.05). See Table 1. Other risk factors influence the magnitude of effect of lower pulse pressure, see Figure 1.
Conclusions: Greater pulsatility and less venous congestion (lower RA pressure), along with other factors, are associated with a lesser tendency for GI bleeding. These findings provide a rational basis for adjusting therapeutic strategies in patients with a propensity for GI bleeding. Insights into the relationship between pulsatility and GI bleeding may drive basic research into potential pathophysiologic mechanisms.
Author Disclosures: J.M. Joly: None. A. EL-Dabh: None. R.N. Brown: None. J.K. Kirklin: None. R. Marshell: None. A. Chatterjee: None. M.G. Smith: None. M.A. Tresler: None. J.A. Tallaj: None. D. Acharya: None. S.V. Pamboukian: None.
- © 2016 by American Heart Association, Inc.